© Leon I. Hammer, M.D.

LESSON ONE

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

Dr. Leon Hammer, M.D.

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

The Contemporary Oriental Medicine Foundation introduces a new

selection of articles and videos from a Master in the world of Chinese
medicine: Dr. Leon Hammer, M.D.

“When I let go of what I

Through these twelve Lessons, Dr Hammer will share with you some of am, I become what I
might be.” - Lao Tzu
the wisdom and knowledge he has accumulated over decades of working
with patients. In addition to imparting some invaluable clinical skills, he
will also discuss some of the issues close to his heart.



Writing about a variety of subjects, from the ever-increasing effects of toxicity on the modern
population, to how we can manage and preserve our own Essence, Dr. Hammer gives readers a
rare window into his exceptional mind. 



Through a mix of writings and videos, the Contemporary Oriental Medicine Foundation presents

Lesson One 1
© Leon I. Hammer, M.D.

an inspiring and useful introduction to the insights Dr. Hammer has gained through more than
sixty years in practice.

We hope that by sharing this information with

the greater Chinese medicine community, we
can help practitioners around the world in their
continuing quest to do great work, and help their
patients to heal.

The Heart Test

We begin this Lesson with something that is
simple, yet also profoundly useful in the clinic. It
is a technique that can be used to assess the
functioning of the Heart, specifically the
presence, and degree, of a deficiency of Heart-
Blood, Heart-Qi, and/or Heart-Yang.

This technique does not require any great skill

with pulse diagnosis, but simply the ability to
feel a pulse and count.

Steps:
1. With the patient seated or lying down - and
rested if she has been rushing - check the
pulse rate at the wrist (by counting the number of beats over a full
sixty seconds). Write it down and label it ‘rate at rest’.
The exterior of the
body is a
2. Ask the patient if she has any limitations that would prevent her from communication centre
swinging either arm around in a circle like a windmill. Does she have of almost infinite
any shoulder injuries, for example?
capacity. Incalculable
patterns of potentially
3. Have the patient stand in a place where she can easily swing her arm decipherable
messages are
without hitting anything. It helps if you are in a position where you can
transmitted from the
easily see the seconds-hand on a clock or watch.
interior to the surface.

4. While feeling the pulse of one wrist, have the patient vigorously swing
her other arm for approximately ten rotations. You tell her when to start and when to stop,
and it is helpful to have the patient stop when the seconds-hand of your watch or clock is at
an easy-to-read number. There is no need to count the number of beats while the patient is
swinging her arm.

5. Once the patient stops swinging her arm, check her pulse rate immediately and without any
delay, this time counting the number of beats for only a ten-second period. Multiply that

Lesson One 2
© Leon I. Hammer, M.D.

number by six, write it down and label it ‘rate on exertion’. Compare the ‘rate at rest’ with
the ‘rate on exertion’ in order to determine any change to the pulse rate that may have
occurred as a result of that brief bit of exercise.

6. If you are not sure of your test result, you could wait for the patient’s resting heart rate to
return to what it was and repeat the test, then average the two ‘rates on exertion’ you have
collected.

Immediately following this small exertion, the pulse rate may stay the same as it was when the
patient was rested, it may increase, or even decrease. This change in rate is a measure of how
the heart handles a request from the body for an increase in circulation.

Interpreting the results:

If you compare the ‘rate at rest’ with the ‘rate on exertion’ and the rate has increased by
between eight and twenty beats per minute (bpm) immediately following the arm swinging, this
is considered a normal response. For example, if the ‘rate at rest’ was 75 bpm and the ‘rate on
exertion’ was 90 bpm, this would be an increase of fifteen beats per minute, and would be
classed as within the normal range. The following changes are indicators of pathology:

• Rate increases by more than 20 beats per minute

Indicates Heart Blood deficiency

• Rate increases by between 30 and 35 beats per minute

Indicates moderate to severe Heart Blood deficiency

• Rate increases by more than 35 beats per minute

Indicates severe Heart Blood deficiency

• Rate increases by less than 8 beats per minute or does not change at all
Indicates Heart Qi deficiency

• Rate Decreases
Indicates Heart Yang deficiency

“The Heart is the sovereign of all organs and

represents the consciousness of one’s being. It is
responsible for intelligence, wisdom, and spiritual
transformation.” - NEIJING SU WEN CH.8

Lesson One 3
© Leon I. Hammer, M.D.

Kidney-Heart Harmony & Disharmony:

Sleep
For this first Lesson, Dr. Hammer has chosen to discuss the relationship between the Heart and
Kidney, with particular focus on its effect on sleep. He begins by considering the association
between the Mind and the Brain, an important indicator of the Kidney-Heart relationship.

The Mind and the Brain

A very significant manifestation of the harmony between the Heart and the Kidney is the
relationship of the mind and the brain, more specifically the mind-spirit (controlled by the Heart)
and the brain-marrow (created and sustained by Kidney Essence/Marrow). Together, they
determine mental stability and function. You could think of the Heart as the software, and Kidney
Essence as the hardware. The Triple Burner mediates this relationship, and should always be
considered in the management of problems relating to the Heart-Kidney connection.

The Kidney-Heart Relationship and ‘knowing’

One of the manifestations of this relationship between the brain and the mind is how together,
they mediate different ways of ‘knowing’.

I will tell a story about a dog, Haysee, who was with me for eleven years while I worked with
adults and children. She was a Chesapeake Bay Retriever - the best duck retriever in the world.
Bred as a fighting dog on the docks of Baltimore, she was first in the water and in the ‘ring’. She
was my son’s dog, but reluctantly lived with me. Haysee was with me constantly when I worked
as a psychiatrist-psychoanalyst with adults, and with children as a child-psychiatrist, sixteen
hours per week.

She slept most of the time, apart from when exceptionally withdrawn people, who could not
communicate with me, came to my office. Haysee sensed these patients - adults and children -
when they came to the door, before they even entered the room. She would wake up and come
out from under the table and sit in front of them, and they petted and talked to her. Of course, I
heard. She also never failed to come out for a person in profound grief. Haysee would
unhesitatingly climb on the couch and sit on their chests until they felt better. She ‘knew’ what
patients needed even when they did not, even before they entered the office.

Haysee, my canine assistant, had access to information not readily accessible to the human
brain. ‘This knowing’ came through her Heart. Antoine de St. Exupery summed it up with "One
sees clearly only with the heart. Anything essential is invisible to the eyes."

Albert Einstein expressed it thus: “The most beautiful thing we can experience is the mysterious.
It is the source of all true art and all science. He to whom this emotion is a stranger, who can no
longer pause to wonder and stand rapt in awe, is as good as dead: his eyes are closed.”
Nietchze said, “And if a man goes through fire for his doctrine - what does that prove? Verily, it is
more if your own doctrine comes out of your own fire.” The Heart!

Lesson One 4
© Leon I. Hammer, M.D.

The Heart-Mind and the Kidney-Brain are both different from, and indispensable to, each other.
The Heart-Mind needs the balance of ego functions performed by the Kidney-Brain: we need to
know how to cross the street or balance our bankbook. Likewise, the Kidney-Brain needs the
Heart-Mind to lend inspiration, spirit, and passion to our daily lives.

Conventional knowing comes from the Kidney-Brain in the form of linear

logic, but a different form of ‘Knowing’ comes, potentially for all of us, as
In their Blood
with Haysee: through the Heart-Mind.
production role, the
Kidneys control the
Proper functioning of this aspect of the Heart is dependent upon a healthy production of all of
amount of Heart Blood, on which memory, attention and concentration the white cells (most
also depend. Heart Blood itself rests upon the strength of Kidney of the immune
Essence, since some of the Blood must be produced in the bone marrow. system), half of the
red cells, and the
Having had a major role in producing Blood, Kidney Essence then
lymph.
depends upon the Heart to move the Blood to where it will do the most
good.

To understand how this reciprocal relationship between the Heart and Kidney affects sleep, let
us consider an example of how their relationship can enter a state of disharmony.

Disharmony through Fear

Fear, especially of the unknown, depletes the Water: it drains the Kidneys. This happens when
the emotional strengths of Kidney Qi, Yin, and Yang – namely faith, hope, love of fellow man and
God - fail to assuage fear. As part of its relationship with the Kidney, the Heart will also provide
an element of protection.

The relationship itself will work to prevent the depleting effect of fear. The Heart-Pericardium
protects the Kidneys (and the whole organism) from the ravages of fear, through what have, in
my opinion mistakenly, been called ‘defenses’. These ‘defenses’ are really survival adaptations
employed by the Pericardium to protect the organism from fear and all excess emotions: shock,
grief, and rage, etc. Defense mechanisms work by distorting the threatening emotions (in this
case, fear) into acceptable forms, or by creating a blockage of these impulses at an unconscious
level.

An example of such mechanisms is ‘sublimation’. This can include creative acts such as
composing music, writing a book or painting, and also the practice of nursing and the healing
arts. Other forms of defense include obsession, a way of displacing fear from consciousness by
thinking constantly about something else, and repression, a way of eliminating fear from
consciousness. Anna Freud describes twenty-two ‘defenses’ in The Ego and the Mechanisms of
Defence (London: Hogarth Press and the Institute of Pyscho-Analysis). I allude to these
‘defenses’ as ‘mal-adaptions’ because they are usually patterns developed during the stresses
of childhood in order to survive, to stay in contact, to stay ‘intact’.

If the protective processes fail and fear gets out of control, then over time there is resultant
physiological chaos. This can manifest either as psychosis, or as what is alluded to as ‘auto-

Lesson One 5
© Leon I. Hammer, M.D.

immune’ disease (I include cancer in this group), or both. An earlier sign of disharmony within the
Heart-Kidney relationship can be seen through its effect on sleep.

Sleep
Let us look at the physiology of sleep from a Chinese medical perspective. For the subject of
this article, the following points are important to keep in mind when considering the effects of
the Kidney-Heart relationship on sleep.

1) During the night, the Blood is replenished in, and stored by, the Liver.

2) By Blood being removed from the general circulation, the Heart and Circulation lose enough
Blood to the Liver to allow sleep. An important point here is that sleep is made possible not by
the Liver having more Blood, but by the Heart and Circulation having less.

3) For the blood to leave, the Heart must be free of cravings and obsessions. As long as the
mind is working, worrying, obsessing, then the Heart is working; Blood is not released to the
Liver, and sleep is very difficult. Likewise if the stomach is working, the Blood is in the
mesenteric plexus; it is not released to the Liver, and instead it remains in the general circulation,
thus obstructing sleep. An exception to this can be for individuals whose sleep is affected by
low blood sugar, in which case a small snack before bed can help.

4) Blood is both replenished and detoxified during sleep and rest.

5) Conversely, while one is awake, Blood replenishment is more difficult since the Blood is
circulating; as a result Blood is consumed, rather than replenished, during the waking hours.

6) If a patient does not sleep, the Blood is not replenished, nor sufficiently
detoxified, even if he has a good diet and breathes correctly.

The convention is that

7) When someone does not sleep, he tends to be worrying or agitated, Blood is replenished
via the Spleen and
which further depletes Heart Blood.

digestive system. My
experience is that
Kidney-Heart Disharmonies and Sleep Kidney Essence
If the water of the Kidney cannot control (cool) the Fire of the Heart, then (Marrow) also plays an
important role in
the mind will become restless, or as Dr. Shen would say, "the Heart is
replenishing Blood, a
sensitive". Also, if the Fire of the Heart cannot descend and warm the
role that is dependent
Water of Kidney Essence, then that Essence cannot rise and nourish the upon harmony
brain. Normal brain function, including sleep, will be disrupted. As I will between the Kidney
mention in an upcoming Lesson, Kidney-Heart disharmonies involve and Heart.
emotional stresses on any or all of the other organs, since humans are
emotional animals. There is no escape from emotions, neither for you nor
for the patient, no matter what unspoken agreement to ignore them there may be.

Lesson One 6
 © Leon I. Hammer, M.D.

Types of Sleep problems

Different types of insomnia manifest with different clinical presentations. Being able to correctly
recognize these presentations is vital to the formulation of an effective treatment plan. The first
of these types we will look at is ‘Mild Heart Qi Agitation’.

Sleep Pattern: Cannot get to sleep for several hours

Diagnosis: MILD HEART QI AGITATION

Symptoms: Worry, obsessive thoughts

Pulse: Varying degrees of Smooth Vibration from Left Distal Position to entire pulse

ACUPUNCTURE

PE-6, SP-6, PE-7, HT-7, CV-4, SP-1, KI-4, HT-5->7 (threaded)

HERBS

If Mild-Moderate Anxiety

Cyperus and Perilla Fruit (Xiang Su San - modified)

Perilla fruit Suzi 6 gm

Cyperus Xiangfu 6 gm
Citrus rind Chenpi 3 gm
Ginger, fresh Shengjiang 2.5 gm
Licorice Gancao 3 gm

As Dr. Heiner Fruehauf

If Acute/Severe Anxiety w/ shock states, the use of
Fushen and Shichangpu
Sheng Mai San + Gan Mai Da Zao Wan - modified
(Poria Fushen and
Acorus, both geared at
Ginseng, American Xiyangshen 9 gm removing phlegm from
Ginseng, Chinese Renshen 9 gm the Heart orifice) has
Ophiopogon Maimendong 9 gm been described in detail
Schisandra Wuweizi 6 gm by the 17th century
Licorice Gancao 5 gm physician Chen Shiduo
in his Shishi Milu (A
Wheat Xiaomai 20-50 gm
Secret Record from the
Date Dazao 5-20 gm
Stone Chamber). Chen
Acorus Shichangpu 9 gm Shiduo describes using
Polygala Yuanzhi 6 gm very large doses of
Cattle stone Niuhuang 1 fen (0.3 gm) these two herbs to
Borneol Bingpian 1 fen (0.3 gm) wake people from what
Flourite Zishiying 10 gm today would appear to
Dragon Teeth Longchi 9 gm be an Alzheimer’s state.

Magnetite Cishi 20 gm

Lesson One 7
© Leon I. Hammer, M.D.

The following formula was mentioned to me by Dr. Heiner Fruehauf for people with palpitations
and/or anxiety that manifest with a Slippery Heart pulse (‘Phlegm misting the Orifices’). It is a
simple, food-based remedy that his Shanghan lun teacher, Dr. ZengRongxiu, paid great attention
to in such situations, and with which Dr. Fruehauf himself was very satisfied.

Cinnamon, Poria, Licorice and Date Decoction

(Guizhi Fuling Gancao Dazao Tang)

Cinnamon twig Guizhi 9 gm

Poria Fuling 15 gm
Date Dazao 9 gm
Licorice Gancao 6 gm

If I were to use this formula I would likely substitute Fu Shen for the Fu Ling.

In these Lessons, Management and Treatment suggestions may be made from time to time, but I
recommend that they not be applied directly as stated. Instead, it is important to take any
suggestions only in the context of a complete Chinese medicine diagnosis of each individual
patient. It is also vital to understand who each patient is as a person, a topic that we will discuss
further in later Lessons.

A quick note to readers: I will use English in place of of pinyin terms wherever possible, for
example Triple Burner and Essence instead of San Jiao and Jing. As I do not speak, read, or
write Chinese, I feel that any use of pinyin here would be an affectation on my part.

In the next Lesson:

Dr. Hammer will continue the Kidney-Heart Disharmony and insomnia discussion, and begin to
delve further into the fascinating world of Contemporary Oriental Medicine.

More information about Dr. Hammer’s work, as well as his regular posts 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., Oliver Nash and Jamin Nichols, and edited by Kira Nash.

Lesson One 8