© Leon I. Hammer, M.D.

LESSON ELEVEN

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

Dr. Hammer is perhaps most known for pulse diagnosis. In previous Lessons he has referenced
this diagnostic skill, and in Lesson Eleven he would like to present an overview of the pulse
system he uses. Integral to diagnosis and essential to treatment, the pulse is too-often
overlooked, and is rarely given the attention, respect, and consideration that it deserves. Dr.
Hammer has spent over forty years studying the system of pulse
diagnosis passed to him by Dr. Shen, and refining this knowledge
with his accumulated experience and wisdom. Contemporary
“Darkness cannot drive out
Chinese Pulse Diagnosis, or the Shen-Hammer pulse system, is the darkness; only light can do
ever-evolving result of Dr. Hammer’s many years of dedicated study that. Hate cannot drive out
and research. It is an incredibly valuable system, and through Dr. hate; only love can do that.”
Hammer’s work and that of the teachers he has certified, we hope - Dr. Martin Luther King, Jr.
that its influence and merit will continue to spread throughout the
world.

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© Leon I. Hammer, M.D.

Chinese Pulse Diagnosis

Much to our detriment, knowledge of Chinese pulse diagnosis has diminished steadily during
the past century. Consequently, its capacity to perceive not only the earliest stages of patterns
of disharmony, but also the process of disease, is sharply curtailed. Chinese medicine is
increasingly losing the ability to serve its highest purposes, including the power to prevent
illness.

The time and patience necessary to master Chinese pulse diagnosis is not synchronous with
civilizations such as ours: those which encourage short term vision of, and limited investment in,
all human attributes. The material that follows, and the books upon which it is based, are an
attempt to revive the teaching that has been passed on to me by a master of pulse diagnosis, Dr.
John Shen. This work represents the integration of hundreds of pages of notes over twenty-eight
years into a coherent conceptual system, and a growing method of teaching small groups.

This introduction of sorts is intended to reawaken an awareness of the importance of pulse

diagnosis to Chinese medicine, and possibly to the future of health care in general. This art-
science has been increasingly neglected wherever Chinese medicine has appeared in our time,
as has been revealed by my experience during the past forty years in all parts of the world
(including and especially mainland China). I am delighted to note that there has, of late, been a
resurgence of interest in the pulse in China and among practitioners of Chinese medicine around
the world; I hope that it will long continue.

The potential value of pulse diagnosis in the twenty-first century is great. In Japan, I once
participated in a conference, the purpose of which was to explore the health care system of the
future. The Japanese government had concluded at that time that its current health care system
was not only dysfunctional, but also too expensive. The participants were representatives of a
wide variety of ‘traditional medicines' from many countries, even from the Sami Laplander
culture. According to the outcome of the conference, the stated direction of future health care in
Japan would be self-help and prevention, in which Lifestyle changes would be vital.

Increasingly, people and governments are acknowledging the

failure of modern medicine to provide affordable, efficient
health care, and there is a growing need to find effective
prevention and medicine. Prevention however, depends
entirely on an exquisitely sensitive diagnostic scheme capable
of accessing the process of disease close to its inception. As
much as scientific instruments and machines become more
and more sensitive, and are able to examine physiology at a
deeper and deeper level, true prevention remains beyond their
reach. In our time, the only available diagnostic instrument
that truly embodies this sensitivity is the art and science of
Chinese pulse diagnosis. 

(While the Ayurvedic and Tibetan models are also highly sophisticated and detailed, they are
simply too unavailable outside of their countries of origin.)

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Throughout my work, I hope to preserve the subtlety of this art/science so that it may serve to
fulfil its amazing potential as an instrument of early diagnosis and prevention. Furthermore, I am
striving to pass on the most extraordinary creative augmentation of this ancient pulse tradition in
generations, by one of the great Chinese physicians of the twentieth century. His legacy enriches
this diagnostic medium far beyond what is known and described in our literature, or what is
taught today in the principal centers of Chinese medical education.

The enormous body of knowledge which can be discerned by touch at the radial arteries would
have been largely unknown to me, had I not had the great good fortune to meet a master of this
tradition in 1974. Dr. Shen's capacity to use the pulse diagnostically left me little choice but to
follow him after our first meeting. His lifelong study of the pulse, and his extraordinary ability to
use it (with all of the many and varied other diagnostic tools at his disposal) to plumb the depths
of his patients left many observers disbelieving, and certain that his wizardry was primarily
intuitive. It was not.

Potential of Pulse Diagnosis

Even while we understand that neither palpation of the pulse nor, for that matter, any other
single diagnostic technique, represents the only vehicle to the truth, let us examine the kinds of
information an experienced practitioner of pulse diagnosis can expect to obtain using this
methodology.

The Past
In terms of the past, one should be able to learn something about the patient’s constitution,
condition at birth, about the course of his life, about his previous illnesses, his emotional state,
and about his habits (e.g., work, exercise, nutrition, drugs and sex).

The Present (Somatic)

In terms of the present, one should be able to say something about Lifestyle and habits, the total
body condition or True Qi, strong or weak constitution. The pulse should also reveal the patient’s
state of balance, in terms of the relationship of the various organ systems to each other, and
between those systems and external factors. A practitioner ought to be able to discern whether
the patient’s significant pathological issues are active or passive, internal or external, related to
Heat or Cold, to Deficiency or Excess, to stagnation or weakness, or to any combinations
thereof. From the pulse, one can ascertain the extent to which the problems that confront the
patient are due to the amount, balance, rhythm and/or circulation of fundamental substances
such as yin, Qi, Blood, Fluid, Essence or Spirit, and the stage of an individual’s condition. The
pulse should also reveal information about the function of each of Dr. Shen’s four Systems:
Nervous, Circulatory, Digestive, and Organ (introduced in Lesson Nine).

Mental-Emotional-Spiritual (Psychosomatic)
From the pulse, we can learn much about the mind and the spirit: mental status and behavioral
style, methods of coping, a patient’s level of stability, his states of worry, guilt, fear, depression,
mania, tension, and frustration, recent and past emotional and physical traumas, recent and past

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sadness, psychotic and/or epileptic tendencies, disappointments, and unexpressed anger.

Central nervous system diseases can sometimes manifest as signs on the pulse. Chinese
medicine and this pulse system illuminate the relationship between the soma and the psyche in
concrete terms: something that has eluded allopathic medicine.

Because the pulse reveals so much on an emotional level, many of my patients have found that
it provides an objective reading of their emotional state. This bypasses their usual resistances to
interpretation, a phenomenon often encountered in psychotherapeutic practices.

The Future (Prevention)

Most importantly for the future, the pulse should allow us to practice preventive medicine. A
practitioner can reasonably predict future body conditions and possible diseases, even those
that may occur many years hence. 

At the far end of the spectrum, the pulse can indicate impending death.

New Challenges
The workshops I have conducted over the years have demonstrated to me that the
interpretations - however considerable - listed in the literature and in my own books leave much
to be learned. Each class I teach enlarges my awareness as I listen to new information emerging
from the practitioners about their own patients, which I can correlate to qualities previously
never suspected. Though that information can be unique to a specific person, it can possibly
also apply to many. As our world changes so rapidly and dramatically, pulse diagnosis must
continue to evolve to meet the ever-growing challenges of modern health and disease.

New diseases and new problems associated with a modern civilization, so very different from
the agricultural society which spawned the original Chinese medicine, have begun to show
consistencies in pulse diagnosis. The ‘ceiling dripping' Scattered pulse of Aids, the various ‘Qi
Wild’ pulses related to Multiple Personality Disorder and Sexual Abuse, the massive increase in
the appearance of the Choppy quality in conjunction with the rise in environmental toxicity, and
the Leather-Hard quality so consistent with exposure to radiation, are among the recently-
identified syndromes which seem to have characteristic pulse pictures. Hopefully, with a
thorough knowledge of the pulse gained through dedicated study, practitioners will be equipped
to explore new worlds, expand the purview of Chinese medicine and serve future generations.

Understanding the Pulse





The Normal Pulse

The Normal pulse is a sensitive and precise measurable standard of health; it is our “gold
standard”. It enables us to detect early deviations from health, and in doing so, provides us with
a preventive medicine. These capabilities are almost completely lacking in our modern health
care system. Deviations from the Normal pulse can reveal a huge amount of detailed information
about a patient, but it is essential that we do not lose sight of the overall picture in all of this
detail.

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© Leon I. Hammer, M.D.

The Pulse as a Whole

I cannot overemphasize the importance of concentrating first on large segments of the pulse, in
order to access and understand the most immediately significant issues for the patient. Of
course, one must always remember that each patient is an individual, with conditions and
symptoms similar, but not identical, to those of any other individual. Therefore, please be
prepared for exceptions to the following.

The broader segments of the pulse include the Rhythm,

Rate, Stability, as well as uniform qualities found on the
entire pulse, at one or another Burner or on one whole
side (left wrist or right wrist). They include also the Qi,
Blood, and Organ depths on the entire pulse (introduced
in Lesson Four).

The tendency to focus on individual positions and

qualities, rather than to look at the pulse in terms of the larger divisions, is an understandable,
but regrettable, error in the teaching and practice of pulse diagnosis. The qualities of the smaller
segments are less reliable signs until the larger picture is addressed clinically. It is, of course,
vital to study in detail the individual positions and the individual qualities, but understanding and
heeding the larger aspects of the pulse as a diagnostic tool is the key to therapeutic success.

If a practitioner is not able to encounter and deal with these broader aspects of the pulse and
their messages, he may not be considering what is most immediately important to the patient.
The larger focus is the most immediate manifestation of a person's condition, and usually the
most significant in terms of its effect on the entire organism.

With regard to the larger picture, Rhythm, Rate and other parameters of Stability are clinical
issues, which take precedence over any other quality, or combinations of qualities, in terms of
diagnosis, management and treatment. Deviations from the normal range of these parameters of
the pulse are generally the most critical of all signs in terms of seriousness of disharmony and
order of treatment.

Any other finding will prove to be enduring despite treatment if Regularity, Stability and a normal
Rate are not achieved first. Once an Irregular pulse is regulated, the other qualities and findings
will probably change automatically.

Stability
By stability, I mean the capacity of an organism to return easily to equilibrium after stress, and its
capacity to maintain operational parameters within the limits of optimum function over time. In
addition to being associated with the regularity of the pulse, stability is also related to the
steadiness of the amplitude and that of the pulse qualities themselves, as well as with the
balance of yin and yang and the balance between pulse positions.

In terms of Stability, qualities in which yin and yang are in contact, and those in which they are
not, need to be considered. One way of understanding deficiency is to distinguish between

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© Leon I. Hammer, M.D.

deficiency that occurs when yin and yang are in contact, and that which is more severe: those
deficiencies that occur when yin and yang have separated. The qualities that fall under these
two categories can occur on the entire pulse, or in one position.

An example of a quality in which yin and yang are still in

contact is the Feeble quality. This is a sign of significant
deficiency wherever it is found, whether in one position
or on the entire pulse. A quality in which yin and yang are
out of contact, or have separated, is the more-significant
Empty quality (discussed in Lesson 04). When this quality
occurs in only one position, it is a sign of extreme
dysfunction of the Organ represented by that position.
When the Empty quality is found on the entire pulse, yin
and yang are out of contact in the entire organism. This
condition is referred to as 'Qi Wild', and the patient is at great risk for serious debilitating
diseases such as cancer, or a degenerative disease of the central nervous system. While the 'Qi
Wild' state applies to the entire organism, qualities manifested by the “Separation of Yin and
Yang” in one Organ will generate chaos throughout the total system, and eventually lead to an
ultimate disorder of Stability, such that the 'Qi is Wild’.

Changing Qualities
Sometimes the pulse qualities literally seem to change under your fingertips: you may feel one
quality, then it is replaced with another, then another, all within one instance of taking a pulse.
When qualities change in this way, in one pulse position, it can be a sign of extreme dysfunction
in the Organ represented by that position. When this phenomenon is palpated in many positions,
these Changing Qualities can be a sign of a serious imbalance from which the patient is at great
risk. I have often observed the latter in seriously mentally ill patients who are on heavy
medications. The ‘can be’ arises from an experience described in my article “The Pulse and the
Individual”. In that article, I described a patient whose qualities were constantly changing, but
who was obviously neither physically nor mentally at risk. She also had a ‘Split Pulse’: a sign of
preoccupation with death. I finally realized that the Changing Qualities were her organism’s way
of keeping me from knowing her. When confronted, she admitted that, although she did not want
me to know, she was contemplating suicide in order to avoid getting old and decrepit like her
parents, who had just come to live with her.

Changing Amplitude
Amplitude is the height to which the pulse is generated from Organ to Qi Depth or beyond, and
is a measure of the yang force - which is roughly equivalent to basal metabolic functional heat -
of the organism. A high amplitude reflects a strong yang force, and a low amplitude is a mark of
diminished yang force and diminished basal metabolic Heat. Changes in Amplitude can feel like
the pulse “drops away” from the fingertips and then returns, varying the height to which the
beats rise. It can involve the entire pulse, or specific areas.

When it is found on the entire pulse, this sign is indicative of Circulatory and/or Heart problems.
In brief, we can say that they may be divided into two general categories: one in which the
Changes in Amplitude are always present (the result of problems with Blood Circulation and the

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Heart), and the other, when the Changes in Amplitude are not consistently present (the result of
problems with Qi Circulation and the Liver due to emotional fluctuations).

When found only in one position, Change in Amplitude is usually a sign of Qi deficiency of the
yin Organ associated with that position. (More rarely such changes are a sign of transition in the
energy of that Organ or area, from better to worse, or vice versa.)

Rhythm
Rhythm is the most significant measure of Heart and Circulatory
function. Instability in the emperor (Heart) is tantamount to chaos in
the empire, and anarchy among ministers and subjects. Unless
Rhythm is attended to first, all other efforts may be in vain.
Irregularity of Rhythm is considered in terms of whether it occurs at
rest or following exertion, whether the Rate can be obtained or is
too chaotic to count, whether the changes in Rate are small or
large, and whether any irregularity occurs constantly or
occasionally.

For example, a pulse that misses a beat regularly and frequently, perhaps once every four beats,
is a sign of more severe Heart Qi, Heart Blood, and Heart yang deficiency than a pulse that
regularly misses a beat, but only once every thirty beats, or one that misses beats frequently, but
not regularly.

Rate
Classically, Rate has been correlated with internal and external conditions of Heat and Cold.
Thus, a uniformly Rapid pulse is interpreted as a Heat condition or hyperactivity from external
Heat or internal Heat, and a uniformly Slow pulse is usually indicative of a Cold condition and
hypoactivity, again from external Cold or internal Cold.

The Rate of the pulse can increase considerably with acute External Pathogenic Heat invasion
and with internal excess Heat, and less with deficient Heat in generalized yin deficiency states.
Rate decreases with acute External Pathogenic Cold, and decreases more consistently in
internal chronic Qi- and Yang-deficiency conditions.

In my experience, however, alteration from a normal Rate is more often a sign of more significant
and far-reaching processes than just Heat and Cold: it is most frequently associated with shock
to the Heart and the Circulation.

Hence, changes in Rate at Rest are more often the result of a shock to the Heart. In the very
young, it represents a shock to the heart in utero, at birth, or in very early life. I found this in a
patient who was resuscitated following a ‘crib death’, and who in later life developed a manic
depressive illness, primarily manic, that is very much a Heart-Triple Burner issue. Very often,
these shocks are emotional. Children and even young adults who have been sexually abused
have changes in Rate at Rest. Rough Vibration on the entire pulse on first impression, a Feeble-
Absent Left Distal Position and large changes in Rate at Rest on a fifty-six year old Chinese
woman led me to believe that she has experienced more than one severe shock. She had been

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in a building that collapsed during an earthquake, and more seriously was a victim of the
Cultural Revolution.

When there are conditions of great deficiency, it is important to remember that the pulse can
sometimes be very Rapid, especially with exertion, due to the instability of the Qi, particularly the
Qi of the Heart. With Heart Qi-Yang deficiency, the rate will vary considerably, even over the
period of a prolonged examination.

Interpretations
The diagnostic significance of each quality is modified from its standard interpretation by other
issues such as body condition and history.

Body Condition

The positions at which a problem will appear, given two patients with identical behavior and
stress, depends to some extent upon the vulnerability of each person’s Organs, as the
disharmony will occur in the most deficient Organ. If, for example, a person does heavy physical
work after eating, the Inflated or Flat quality will appear in either the Stomach or the Intestines,
depending upon which Organ is weakest. Likewise, if a person is repressing anger and the
Lungs are weaker than the Liver (the Organ commonly associated with anger), the Lungs will be
affected first.

Organs Systems and Body Areas

As a general rule, pathology in areas of the body such as the chest, abdomen and pelvis may be
distinguished from disharmony in a yin or yang Organ alone when the same quality appears
bilaterally, either at the same position, or between the distal and middle positions. A quality
appearing in both the left and right distal positions may indicate problems in the chest area; the
same quality appearing only in the left distal position would indicate pathology in the Heart
organ. Pathology in both a body area and an Organ can, of course, occur simultaneously.

Position and Sensation

The qualities feel somewhat different depending on the position. For example, a Tight
Pericardium pulse at the left distal position feels more like a sharp point sticking the finger,
compared to a more string-like Tight sensation at the left middle position.

Position and Interpretation

The same quality sometimes has a different meaning from position to position. A Slippery quality
can mean a Liver infection (parasites) when found on the left middle position, Spleen Damp or
stagnant food when found on the right middle, and pregnancy or elevated lipids when found on
the entire pulse. Slipperiness at the Blood depth can be a sign of blood toxicity or excess
viscosity (elevated cholesterol). Slipperiness at the Qi depth with a fast rate can mean Glucose
Intolerance, and with a slow rate, it can signify Qi deficiency.

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© Leon I. Hammer, M.D.

The interpretation may vary even in the same position depending on the other qualities and
conditions which accompany it. A Slippery pulse, for example, on the left distal position (Heart
and Pericardium, according to my tradition) will vary in its clinical meaning,
depending on the following factors. If the Slipperiness in the Heart pulse is
rather general, and the pulse Rate is normal or a little Slow, most likely
you are dealing with a condition of Phlegm ‘blocking the orifices of the
Heart'. In western medical terms, we might encounter either
severe anxiety or depression - which of the two was present
would be indicated by other pulse findings - or more rarely,
epilepsy and/or schizophrenia. If the pulse is Slippery and 

Rapid, the condition might be Phlegm-Fire, which is associated
with mania. If the Slipperiness is acute, the pulse is very Rapid
and the patient exhibits a high fever, the person may have
myocarditis. If the Slipperiness is felt only in one small area on
the lateral side of the pulse near the left distal position, rather
than generally throughout this position, one is more likely

dealing with a heart mitral valve defect. This is the Mitral
Valve position, and Slippery here indicates mitral valve
regurgitation (and prolapse), associated in Western
medicine with phobias and panic attacks.

Consistency
Qualities which can be considered signs of serious pathology are generally to be so interpreted
only if they are found consistently. If they are found inconsistently, the meanings can be different,
and are usually less serious.

Restoration
All pulse qualities are a sign of the attempt of an organism to restore itself, or of its failure to do
so. A Rapid or Pounding pulse can be a reflection of the body overworking in its attempt to
compensate for deficiency, itself likely the result of the patient having gone beyond his energy, in
one way or another. An Empty pulse is a sign that the compensatory measures are failing.

Early
The early stages of disease are almost entirely due to some interference - stagnation - with
normal function which frequently goes unobserved. Taut, Tense, Flat, Inflated, Choppy, Slippery,
Floating and Cotton are some of the qualities associated with stagnation. If the stagnation is
preceded by a constitutional deficiency, the pulse signs of stagnation will be mitigated by
qualities such as Reduced Substance, Diminished Qi Depth, Deep, Feeble-Absent, and Diffuse.
These qualities will be especially noticeable at the Proximal Positions, which reveal the state of
Kidney Essence.

Middle
The middle stages are attempts at recovery, and would include the Rapid, Robust Pounding
(pounding with force), Blood Heat and Blood Thick, and slight Full-Overflowing, among others

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© Leon I. Hammer, M.D.

that represent the organism’s attempt to eliminate the Heat which is a consequence of lingering
stagnation. Reduced Substance, Diminished Qi Depth and Diffuse also occur at this stage, when
the body’s attempt at recovery is failing.

Later
In the later stages of disease, the pulse reveals deficiency of substances, and eventually shows
signs of chaos. Some examples of qualities associated with the later stages of qi deficiency
would be Reduced Pounding (pounding without force), Deep, Feeble, Absent, Empty, Scattered,
Minute, Yielding Hollow Full-Overflowing, very Rough Vibration, Interrupted and Intermittent. The
Thin pulse is a sign of significant Blood deficiency, a Tight pulse is a sign of advancing yin
deficiency, and a Wiry pulse is a sign of Essence deficiency. The Muffled quality, associated with
neoplasms, is a more serious sign of mutation, except in the Left distal Position, where it is a
sign of heart-felt depression.

Balance
Finally, we come to the issue of balance. Whenever a
practitioner finds a great disparity between the pulse and
other sources of diagnostic information, he is usually dealing
with a more serious situation. The importance of balance can
also be seen in the fact that it is preferable, under ordinary
circumstances, to have a completely Feeble-Absent pulse
than to have one in which each position and each depth has
a different quality. A general Feeble-Absent pulse indicates
vulnerability, whereas a Chaotic range of qualities is disease.

Chaos is the most serious of all conditions. It is encountered with alterations of Rhythm either on
the entire pulse, or in one position where it is experienced as instability, with frequent Changes in
Amplitude and/or Qualities, with widely varying qualities from one position to another: it is where
yin and yang have lost functional contact with each other. When this affects the entire organism,
we feel pulse such as Empty, Scattered, Minute, and Yielding Hollow Full-Overflowing on the
entire pulse, representing systemic separation of yin and yang. This has become known as the
‘Qi Wild’ condition mentioned above, something we will discuss in more detail in a later Lesson.

Learning the Pulse

This once-secret pulse system was formerly handed down in the Menghe Lineage from father to
son, over the course of many centuries. For the first time in history, it is currently being taught in
a systematic, organized fashion, to small groups. Now, larger numbers of people around the
world have access to this remarkable diagnostic methodology, and can learn the system in
relatively short periods of time.

The most essential element to learning this pulse system is study with a senior pulse instructor.

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Pulse diagnosis is a meditative process: an individually-developed art-science form: a blend of

learning skills and respecting intuition. The more one empties one’s mind of its routine chatter,
and focuses with steady serene concentration on the sensations at his finger tips, the closer he
will come to reality. Take the pulses of many people, and ask many questions. Stay with the
pulse of every patient for a long period of time. It is only with experience that a practitioner can
quickly evaluate a pulse in terms of a differentiation between the enduring and the transient
aspects of what he is feeling.

One must always keep in mind that no single modality was ever meant to be used by itself,
alone. The practitioner integrates the pulse with other guides to diagnosis: with looking,
listening, asking, and all the other forms of touching. As I said previously, whenever there exists
a great disparity between the pulse and other sources of diagnostic information, the condition is
likely to be more serious.

The pulse is ultimately the most important diagnostic tool available to a practitioner of Chinese
medicine, if one is willing to focus, to practice, to search, and to be patient.

The best (perhaps only) way to learn pulse diagnosis is from a teacher. 

There are a number of certified instructors around the world; they are qualified to pass on Dr.
Hammer’s understanding and teach the practical elements of this art and science. A list of these
instructors is available here: www.dragonrises.org/pulse_diagnosis_teachers.html


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 Eleven 11