© Leon I. Hammer, M.D.

LESSON THREE

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

This Lesson starts by describing how subtle colors on the face can
reveal early insults to physiology. The depth of hue and its location
are incredibly useful diagnostic features, and we hope that you will
find the information helpful in your practice.
“Live your own life,

with all your heart,

Dr. Hammer then begins to introduce the subject of Lifestyle. Often- with all your mind,

ignored, but so vitally important to our overall health and well-being, and with all your soul”
Lifestyle is a vast topic that we will do our best to make - William Martin
understandable and approachable. Spanning several Lessons, Dr.
Hammer’s discussion of Lifestyle will give you a new and different
perspective on your patients, and on yourself.



First though, we look at some of the manifestations of shock.

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© Leon I. Hammer, M.D.

Face Color and Shock

A blue or blue-green color found on the face is a
sign of emotional ‘shock’.

This shock can be interpersonal, or associated

with physical trauma that is experienced as
emotional trauma. While it can impact any
vulnerable organs or areas of the body, such a
shock especially affects the Heart and Circulation
(Chinese concept).

The color – its depth, shade, and location on the

face – is determined by two things:


1) Timing – at what stage in development the shock occurred.


2) Severity – the degree of shock.

Severe emotional shock or the use of alcohol or recreational drugs at conception and in early
pregnancy will cause more damage to physiology than if these things happened just prior to, or
during, birth. This is revealed in the face color: the earlier in the pregnancy the shock, alcohol or
drug use occurred, the deeper the blue color on the face, and the larger the area it affects.

The degree of shock is also important, determining the depth, as well as the location, of the blue
color. The more severe the shock (or the greater the use of drugs or alcohol during pregnancy),
the deeper the blue and the more of the face it covers, whereas the less severe such things
were, the lighter the blue color will be (it may even appear as a more blue-green hue).

A profound shock sometime after birth (in my experience, during young adult life: teens to thirty
years of age) may also manifest as a deep blue color on the entire face. Each of the above
instances usually creates a profound and enduring feeling of fear within an individual, reflected
by a Rough Vibration on the Entire Pulse.

Specific locations
A blue color on the chin is a sign of a mild to moderate shock that occurred later in pregnancy.
Examples include caesarean without complications, and late-stage prematurity. With shock that
occurred just before or during birth, the blue will be around the mouth, and examples may
include ‘cord around the neck’ or breech presentation (each with its own unique pulse signs). In
the case of a life-threatening shock at birth, such as placenta previa or very early prematurity,
the blue is of a deep hue, and could be on the entire face.

Blue found only on the temples indicates a major shock that could have occurred during any life
era, but was of a less severe nature than if the same color is found on the entire face. The blue
color, found simultaneously on the temples and between the eyes, is a sign of shock that

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© Leon I. Hammer, M.D.

occurred between ages six months and three years. The same color found between the eyes
and on the nose indicates shock at a later stage of development, probably after the age of
twenty, and probably less serious in nature.

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© Leon I. Hammer, M.D.

Related signs
There are also some related facial signs:

A vertical line between the eyebrows/eyes is a sign of a ‘shock in-utero’, and one line is not as
serious as two. The degree of seriousness is also indicated by the depth of an accompanying
blue color in the same area, the deeper the color, the more serious the shock and clinical
consequences.

Another sign results from the fact that emotional shock creates imbalance in the ‘nervous
system’, this may be indicated on the face by very thick eyebrows in which one cannot see the
individual hairs. Dr. Shen also observed that when an individual’s eyebrows are dark and thick,
you cannot ‘see inside of the person’. These patients may be impulsive, think fast, and act
without thinking. When the eyebrows are dark and less dense, the individual tends to be
powerful, intelligent and creative.

Clinical
It can be difficult to differentiate those ‘insults’ caused by genetics (DNA) or weakness of
inherited pre-natal Essence, from a ‘shock to the fetus’. The generic term ‘constitution’ is
unhelpful as an indicator of etiology in these cases.

Other than those mentioned above, the pathophysiological consequences of shock are difficult
to predict. However, we can safely say the Heart and Circulation will be adversely affected, and
that, almost always, a blue color found on the face is accompanied by a profound feeling of fear,
and signs of a Rough Vibration on the Entire Pulse.

The depth and location of a blue color on the face can provide us some idea of the degree of
‘insult’ suffered by an individual. If the origin of the shock was during pregnancy, we are
informed that Essence has probably been affected; the degree partially determined by how early
in-utero the shock occurred.

With a shock in-utero that occurred closer to or at birth (blue color on chin and/or around
mouth), we are still somewhat concerned about Essence, but more concerned about the effects
on Qi and Blood. We are also more concerned about Yang than we are about Yin (except where
incubators have been involved). The later in life the shock occurred, the lesser the effect on
Essence, Qi and Blood. Therefore, depth and location of colors on the face can be useful in
helping us determine which of, and to what degree, these substances may have been affected.

Depending on the patient and our working relationship, all of the above information can be
useful to share, since color, and its location on the face, are things patients can see for
themselves. I share such diagnostic features because sometimes, I find it necessary to explain
to patients why I spend hours taking their pulse, why I look at their tongues, eyes and faces,
compare the color of someone’s face to the color of his hands, and more, and why I spend so
much time thinking about what we should do.

For the young who are unwell, I turn to Dr. Shen’s exclamation: “How can be? Brand new!” This
indicates that the problem must have begun ‘in-utero’ or at birth, since the young have not really

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© Leon I. Hammer, M.D.

been around long enough for their lifestyles to create problems. With older children and adults,
the story is quite different.

“Chinese medicine in the life”

Dr. Shen repeatedly said, “Chinese Medicine in the life”. More specifically, he said, “In Chinese
medicine, ten percent is treatment, and ninety percent in the life”.

He was explaining that the truly successful practice of Chinese medicine comes not just from
the application of herbs or acupuncture, but also from attempts to understand patients’ lives,
ascertain the cause(s) of their complaints, and help them to achieve lasting change through
altering the way they live.

Of course, based on his understanding of the patient, Dr. Shen applied treatment to address the
damage that had already been done, but he was also aware that the success of his treatments
could stand or fall depending upon the actions of the patient. In fact, he made it abundantly
clear that, without changes in Lifestyle, the prescribed treatments would not succeed.

A common admonishment to a patient who was not recovering was, "Your fault, not mine. What
you do?” By this, he asked his patients in which ways they were going beyond their energy and
abusing themselves, and therefore rendering his considered treatment unworkable.

Frequently, of course, Lifestyle problems are responses to emotional stress. When treating
patients for whom this was the case, Dr. Shen prescribed that they "stop worrying". This
somewhat infuriated his psychologically-sophisticated New York City clientèle, and he referred
them to me.

Each of us will practice Chinese medicine in his or her own unique way, but it is worth
remembering that Dr. Shen was incredibly successful in his practice, and that he attributed a
large part of this success to that which most of us afford only a cursory glance…

Lifestyle
The subject of Lifestyle is vast, and beyond this, or perhaps any, Lesson. So, we must be
selective in the material we cover. Over the next couple of Lessons we are going to look at
several important and often-overlooked aspects of Lifestyle, each of which on its own can
dramatically improve both understanding of pathology and effectiveness of treatment/
management.

You will notice my use of the term ‘management’. It is not simply to avoid the term ‘treatment’; it
is to avoid the connotations of a treatment being something that is given or prescribed, to a
patient, by a practitioner. I use the term ‘management’ to mean a plan that is constructed by the
patient and practitioner working together to understand the patient’s situation and the best way

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forward. It can involve herbs, acupuncture, and visits to other practitioners, but it also includes
an understanding of what needs to change in order that a patient may truly begin the process of
recovery.

The start of our journey

Beginning at the beginning, we need to consider that we do not all start life on the same footing,
or with equal energy. The main subject of this Lesson - Lifestyle - is congruous with the
emerging discipline of epigenetics, which studies how life experience, from conception through
old age, alters the function of genes (our constitution). Environmental, chemical, emotional and
physical stresses turn genes on and off: a process that begins in our parents, before conception,
and continues through pregnancy, birth, early infancy, adulthood and old age. In this way, what
we start out with is affected by how we live.

Chinese medical diagnostic tools are capable of detecting damage to our Essence through
constitutional, genetic, or in-utero defects that may manifest later in life. Indicators appear at a
more subtle level, often much earlier than defects become obvious. These subtle indicators can
be revealed through face color and the pulse, as well as through symptoms and history. Signs of
genetic errors, or shock during pregnancy or at birth, show on the face; some of these have
been described at the beginning of this Lesson.

Genetics, or what we call constitution, is largely a susceptibility to disharmony. The factor

controlling the unfolding of the genetic blueprint is Lifestyle: the day-to-day support through
reasonable living, or abuse through immoderacy, that determines the physiologic and
psychological manifestation of constitution-genetics. Put simply, Lifestyle is what we do with our
innate Essence.

What we do with what we have

Dr. Shen used everyday analogies to explain his concepts. With regard to Lifestyle, he used one
involving an object familiar to all of his clients: a car. He said that there were four kinds: one is
good and well cared for, one is good and overused, one is poor and well cared for, and the other
is poor and poorly cared for.

Obviously, the good car that is well cared for will be the best. However, the point he was making
was that the poor car that is well cared for will be better than the good car that is neglected.

The ‘quality of the car’, I consider the ‘terrain’, and the care of car (which includes what we do
with it), the ‘stress’. We are not all born with an equal ‘quality of car’. This is part of our ‘terrain’,
upon which life (the provider of our ‘stress’) plays out. Terrain represents the totality of an
organism, from what is inherited, to what has thus far been done with that inheritance through
the entirety of life, in all dimensions: physical, mental, emotional and spiritual. As people’s lives
evolve and change, so does their terrain.

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© Leon I. Hammer, M.D.

Terrain
The interaction of stress upon terrain is one of the subjects that can decide the evolutionary
direction taken by a system of medicine. One can choose to believe, as Louis Pasteur did (at
least for much of his life), that the most important aspect of this interaction is the ‘stress’, for
example the bacteria. Or, one can view the issue as Claude Bernard and Antoine Béchamp did:
unlike Pasteur, they designated the key issue as ‘Le Milieu Intérieur’ (internal environment), or
terrain. They believed the immune system to be a more significant element than the bacteria.

Understanding one’s own terrain (or of what one’s car is reasonably

capable) can be incredibly liberating, particularly if the terrain is not
really able to handle the stress imposed upon it.

This has played out over and over again when people with lesser
terrains are informed that they were never meant to, for example,
run three businesses at once. So relieved are such people that they
often break down in tears. This has even applied to adult men, who
are finally free of the imperative to perform beyond their inherent
endowment. I have seen profound changes in people’s lives with
this liberating information.

Diagnostically, we can differentiate the terrains of our patients,

assess their ‘quality of car’, and advise accordingly, informing them
of the limits of stress they can endure without developing
symptoms. Therefore, perhaps a person with a good terrain can do fifty sit-ups without
untoward depletion of their Qi, while a person with a lesser terrain might be advised to do only
ten.

Causes are part of diagnosis

Ted Kaptchuk has said that in Chinese medicine there is no cause, only patterns. 

With his statement, he was actually, and quite correctly, attempting to shift our focus from the
biomedical model of a single external pathogenic factor - a bacteria or virus - to a more inclusive
model that involves a multitude of interacting factors which create a pattern.

However, even patterns do not tell us about the individual who has the pattern, how it began,
and how it is sustained. No solid-hollow (zang-fu) pattern has ever described more than an
approximation of a person. We need to know a person reasonably well as an individual, and not
just a pattern, to engage him in the process that begins with awareness and that ultimately
changes the behavior that created their presenting problem: a behavior that almost always
obstructs the path of healing. We call that behavior ‘Lifestyle’. As Lifestyle is a primary cause of
disease, it must inform a diagnosis if there it to be truly successful treatment.

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© Leon I. Hammer, M.D.

Convincing patients
A great many ‘stresses’ impact our ‘terrain’. Before we look at the first of our Chinese medicine
subjects relating to Lifestyle, I am going to share a simple example, one that emphasises the
importance of Lifestyle and the impact it can have upon health. It is useful because it is an
example that can be easily shared with any patient: sugar.

It is perhaps the most appealing flavour to the taste, and is so often used as a balm to the
‘bleeding’ heart. Sugar descends upon children and adults in the most convenient breakfast
foods, and for the rest of each day is available in every type of food imaginable.

In the form of glucose, there is, on average, the equivalent of a single teaspoon of sugar
circulating in the entire blood stream of a human being at any given time. In order to avoid coma,
excessive levels of sugar are removed from the blood. Small amounts of this excess sugar are
stored in the liver as glycogen, which can then be released back into the blood when there is a
deficiency of glucose, and so prevent insulin shock.

Further excess sugar, above and beyond that which can be kept as glycogen, is stored in the
body as white fat, the kind of fat that absorbs fluid and increases weight (this is why, especially
in women, herbal diuretics will reduce weight).

Safe levels of sugar in the blood stream are those that avoid either extreme: coma (high levels)
and shock (low levels). This safety range is very, very small: between 3.3 and 7 grams in the
entire blood system. Imagine then, the stress put on the adrenals, pancreas and liver when a
single chocolate cookie can contain 8 grams, and some candy bars as much as 50 grams, of
very quickly absorbed sugar that rapidly enters into the blood stream. After eating something as
simple as a candy bar, the body has only a few minutes to reduce the amount of sugar in the
blood back to around 4 grams in order to prevent coma.

If eating just one cookie can raise blood sugar to twice the upper safety level, consider then the
daily sugar content in the average western diet (163 grams per day in some countries). Our
‘terrain’ must manage the onslaught of this ‘stress’, just to keep us from slipping into a coma.
Consider how a lifestyle involving regular and excessive consumption of sugar, repeated over
and over since childhood, affects physiology. It diminishes our terrain by placing a great deal of
stress on the adrenals, liver and pancreas, thereby enhancing the onset and exacerbation of
chronic disease.

Resolving causes
Lifestyle is a major cause of disease, and identifying a damaging lifestyle is an important step in
diagnosis. However, to enable a patient to change, we must discover what drives his destructive
behaviour(s). Although abuse of one’s life may stem from circumstances, or from ignorance of
what makes a healthy diet, routine, or living situation, etc., it may also be an attempt to resolve a
life-problem that seems, at the time, to have no other resolution. In the case of our sugar
example, it may be that a child develops a “sugar habit” simply because, in her household,

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© Leon I. Hammer, M.D.

sugary snacks are readily available. Or, it could be that she lives in an emotionally-deprived or
abusive family, and does not have sophisticated resources to mend her ‘heart-pain’. In this case,
something as simple as sugar provides a readily-available consolation.

The emotional suffering of a ‘bleeding’ heart can cause a patient to abuse something such as
sugar unwittingly. However, no two bleeding hearts will be the same, nor will any two patients.
We must focus on each patient as a unique individual, and on each lifestyle choice as a
reflection of someone’s specific situation: be it ignorance or an attempt to resolve the seemingly
unresolvable. Only then will we have the chance to initiate real and lasting changes in our
patients’ lives, and to help them achieve true recovery. This philosophy can be applied to many
aspects of the lifestyles that damage us all; sugar is just one small ingredient in our culinary
lives, and food is just one small part of what makes up our Lifestyles.

The problem with patients

If you choose to heed Dr. Shen’s experience and devote more time to helping patients realize
and resolve unhealthy Lifestyles, then you may encounter an unfortunate truth: the patient is
working against himself and against you, and ‘entropy’ is also countering you both. Often
patients want you to make it possible for them to continue doing that which created their
symptoms in the first place, without paying a price, and without feeling pain. Patients may come
with the expectation that you will make it possible for them to continue the abusive Lifestyle that
has made them ill, whilst allowing them to avoid the consequences.

However, life is your ally. ‘Becoming’ is the evolutionary energy of the

universe. This positive power is constantly moving us forward against
the forces that diminish life: the fear of the unknown that causes
people to resist change, and the deadening of awareness that helps
them suppress the pain of a stagnant existence. A patient can undo
the effects of his past abuses if you, the practitioner, engage the
totality of his life force.

For now, if you are practicing, I encourage you to consider what we

have discussed in this Lesson. Look even deeper at the lives of your
patients to see if, and in what ways, Lifestyle is creating and/or
maintaining any of the disharmonies that you are working to resolve with your treatment.

In a nutshell
To sum up this Lesson: The symptoms and signs of a Chinese medical condition are the fallout
of the stress-terrain interplays of Lifestyle and constitutional viability within an individual. As
such, Lifestyle is a major cause of disease. To enable true recovery, both practitioner and patient
must assess and understand how the patient lives. The success of any treatment may stand or

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fall based upon how willing we are as practitioners to dig deep in our understanding of a
patient’s life, and how willing the patient is to address some of the real causes of his disharmony.

In the next Lesson:

Dr. Hammer discusses some of the practical aspects of Lifestyle, how they impact health and
create disharmony, and how they can be managed. We will start with something that is
incredibly common, though little-understood, and that has an enormous impact on health and
the ability to make a true recovery: over-work and over-exercise.

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. and Oliver Nash. Editing and design by Kira Nash.

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