Professional Documents
Culture Documents
Lesson08thinkific 1511875445357
Lesson08thinkific 1511875445357
Lesson08thinkific 1511875445357
LESSON EIGHT
Contemporary Oriental
Medicine Foundation
1000 NE 16th Ave.,
Building F, Gainesville,
FL 32601, USA
In Lesson Eight, we will first finish our discussion of Blood with an examination of hemorrhage
and its associated pulse quality, Hollow. Dr. Hammer then explains the significance and
implication of the Liver, and its deficiencies, in menstruation. Finally, Dr. Hammer discusses
radiation: a very important subject that, while it affects us all with
constantly mounting severity, is rarely seriously acknowledged and
even more infrequently addressed. Radiation is now a constant
companion for many people, and has brought with it a myriad of “Live in joy, in love, even
among those who hate.”
illnesses. Dr. Hammer will explain the modern progression from the
- Jack Kornfield
Choppy pulse quality, associated with toxicity, to the now-worryingly
common finding of the Leather-Hard quality; a manifestation of a
dangerous internal situation brought about by repeated and
prolonged exposure to radiation.
Lesson Eight 1
© Leon I. Hammer, M.D.
Hemorrhage
Absolute Hollowness at the Blood depth, combined with a Leather-Hard sensation at the Qi
depth, is an extremely important sign indicating severe hemorrhage. This is called the Leather-
Hollow pulse quality, and it does not have the same sensation or meaning as the Yielding
Partially Hollow quality we discussed in the previous Lesson. Instead, the Qi depth feels like
Leather, the Blood depth is completely and totally Hollow, and the Organ depth is clearly defined
from the Blood Depth. With this pulse finding, if the pulse is Rapid, the hemorrhage is imminent.
If the pulse is Slow, a hemorrhage has already passed (but could occur again).
This is what I call a RED Button pulse (condition): one that calls for emergency response, no less
than an ambulance to an emergency room.
I recall one experience when I was visiting an acupuncture college, and because of my pulse-
taking skills, I was asked to leave a class I was attending to take the pulse of a patient. This
person’s pulse was as just described, and Rapid. I suggested that he be taken to an emergency
room, but they dismissed what I was saying, indicating that they knew how to take care of it. I
learned the next day that this man did eventually attend the emergency room, having vomited a
great volume of blood from an ulcer. He died three weeks later from the same condition.
Liver Qi Stagnation
This is an area where my understanding differs slightly from that of the Chinese medicine
profession in general: what the profession calls ‘stagnant’ and labels as pathology, I call
‘Containment’ and label as a normal function of the Liver.
Lesson Eight 2
© Leon I. Hammer, M.D.
Ordinarily, the Liver provides Qi to, and moves Qi and Blood in, all of the organs, enhancing
natural function. The effects of this can be seen with inspiration and expiration in the chest and
lungs, with the movement of food down through the esophagus, Stomach, Small and Large
Intestines and rectum, in the passage of water through the Kidneys, ureter, Bladder, and urethra,
and with the movement of Blood to, and through, the Heart to the entire body.
One function of the Liver is its role in the movement of Qi, and in turn whatever Qi ‘moves'; I see
the Containment of Qi as another. For example, the storage of Blood is a function made possible
by the Liver’s ability to ‘Contain’ the Qi, and thus ‘hold’ the Blood that is moved by Qi. The
Containing and Releasing of Qi allows the Liver to Contain and Release Blood. It also enables it
to Contain and Release emotions. The Liver’s role in the free flow of emotions is intimately
bound to this dual function, giving us not only the ability to allow our emotions to flow freely, but
also the ability to contain (repress) them. This vital function of the Liver enables the existence of
a ‘civilized’ society: one in which we do not all go around expressing our every feeling.
I consider that ‘stagnation’ of Liver Qi can therefore result from Liver Qi deficiency (because the
deficient Liver cannot properly perform its function of Containing and Releasing/moving Qi), or
from repression (where the Liver is performing its function of Containing emotion, and thus Qi).
Liver Qi likes to move. It is important to note that neither of the above two forms of ‘stagnation’
requires the practitioner to ‘move’ Liver Qi: one form is ‘stagnation’ due to the Liver being too
Qi-deficient to move adequately its own Qi, and the other is the ‘stagnation’ of the Liver as it
performs its natural function of Containment.
Either of these ‘stagnations’ will interfere with the Liver’s function of moving Qi in other organs,
and in body areas. As Qi stagnation manifests as pain, we can see how intermittent pain that
rises and falls with emotional vicissitudes and changes in the patient’s strength is associated
with ‘stagnation’ of Liver Qi. Fixed pain is associated with Blood stagnation that is not as easily
influenced by passing changes in stress and strength.
‘Excess’ Liver Qi
There is always talk of the Liver ‘attacking’ other organs. However, I believe that Liver Qi is
interested in promoting function. The Liver creates, moves, and directs Qi everywhere in the
body. You don’t take a breath without Liver Qi playing some part it in. I consider that the only
time Liver Qi can be labelled ‘excess’, is when it cannot be successfully contained. When it
escapes the Liver chaotically, Liver Qi goes to the most vulnerable organ or body area and
interferes with function, rather than enhancing it, or it becomes an independent pathogen.
Liver Heat
‘Escaping’ Liver Qi is often accompanied by Excess Heat. When, for whatever reason, there is
‘stagnation’, or too much Containment/repression of Liver Qi, the body tries to move it, using
metabolic heat. If that heat accumulates, then it changes from being metabolic heat to being an
Excess Toxic Heat.
Lesson Eight 3
© Leon I. Hammer, M.D.
Excess Qi and Heat will escape when the Liver can no longer contain them, affecting the most
vulnerable organs. The target of this escaping Qi and Heat can also be a vulnerable area of the
body: the breast, for example, as we will see in the next section.
It is important to consider that if Qi escapes from the Liver, then that Qi is ‘Wild’. It no longer
enhances function; it is still Qi, only now it is Qi that interferes with function. Escaping Liver Qi is
a form of what Dr. Shen called ‘Qi Wild’.
It is my contention that the exigencies of the pre-menstrual phase are primarily dependent on
the integrity of Liver Qi. While most of the following symptoms are a result of the stagnation of
Liver Qi, the issue we must raise regards what is causing this stagnation. I feel that the
stagnation, in our time, is more often due to a deficiency of Liver Qi and its subsequent
inability to move the Qi, than it is to the inhibition of that movement due to repression of
Liver Qi.
Premenstrual symptoms include tension, anxiety, irritability, crying, mood swings, parietal
headaches, abdominal bloating and cramps, breast tenderness, insomnia, joint and/or muscle
pain, fatigue, acne, and eye problems. Let us examine them from the perspective of Liver
function. The Liver’s role in moving blood to the uterus in the premenstrual time supersedes
almost all of its other functions, since from nature’s point of view, the perpetuation of the species
is paramount.
(Periods will cease, however, in women who exercise excessively. This is an attempt by the Liver
to place the survival of the body before the need to reproduce: excessive exercise means that
Lesson Eight 4
© Leon I. Hammer, M.D.
the involved muscles, ligaments, tendons and peripheral nerves require so much Blood that
there is not then enough available for menstruation.)
All of the premenstrual and menstrual problems described below are due to a Qi-deficient Liver
that is unable to perform its roles of: storing and providing blood for general circulation (dull
deficient headaches), detoxification (see below), containing excess Heat and Qi that rise (breast
tenderness), and moving Qi in such places as the Stomach (regurgitation), among other
locations.
With regard to the Liver’s responsibility as the detoxifier, we note that toxins that cannot be
easily excreted become Retained Pathogens. One of the principal places that toxins - physical
and emotional - are retained is in the Blood stored in the Liver. It is the movement of the Qi that
continues to eliminate toxins from the body. Many functions depend upon the integrity of Liver
Qi. Skin problems during the pre-menstrual time are an effect of the Liver’s role in detoxification.
Again, if the Liver is unable to eliminate toxins, they will stay in the blood or in other tissues
(joints, muscles). The body tries to remove toxins from the Blood and excrete them through the
skin, causing skin rashes. If there is also a damp condition (a Damp Spleen), the rash will have
some pus, as with acne (which is common premenstrually).
Breast tenderness is attributed to excess stagnant Liver Qi escaping, and instead of performing
Liver Qi’s normal function of enhancement, it interferes with the function of vulnerable organs,
and with vulnerable areas. When Liver Qi is chaotic, it cannot perform effectively its task of
moving Qi smoothly through the breast, and so pain associated with Qi stagnation occurs. This
symptom implies Liver Qi “stagnation”, but the escape of chaotic Liver Qi can be attributed
either to a surfeit of repressed Liver Qi, or an inability to contain what there is due to Liver Qi
deficiency. This pain may also happen when the Liver is too weak to move the Qi in the breast.
In both of these scenarios (Liver Qi deficiency and chaotic Liver Qi escaping), breast pain occurs
more commonly during menstruation because the Liver is using its Qi to move Blood to the
uterus, meaning it has less Qi available with which to perform its functions of moving Qi in the
breast, or containing Qi within the Liver (if the Liver is less able to contain Qi, then more
escapes).
The predominant headache during the menstrual and premenstrual time is of a dull nature,
primarily from Blood deficiency. The deficiency is due to the urgent need for the Liver to move
Blood to the uterus, leaving less for other functions. Other symptoms such as muscle pain have
the same source, since they also depend upon Liver Blood for efficient function. Likewise, Liver
Blood nourishes the ocular muscles, and its deficiency can account for ocular difficulties during
the premenstrual phase.
Peristalsis, and the movement and direction of Qi, are functions of Liver Qi. Therefore,
abdominal bloating and cramping in the pre-menstrual stage are also attributable to Liver Qi
deficiency.
The Liver, in both Western and Chinese medicine, produces energy. This energy helps recover
general levels of Qi when one is tired, but needs to carry on. This means that when the Liver is
Lesson Eight 5
© Leon I. Hammer, M.D.
occupied with moving the blood to the uterus, it is less able to help recover the overall levels of
Qi, and so fatigue comes more easily.
Migrating joint pain is due either to deficient Heart-Circulation, in which case both the pain and
the Heart-Circulation will be improved with rest and exacerbated by fatigue, or it is the result of
Liver Qi deficiency-stagnation. The latter is made worse with stress, and again is due to either to
a surfeit of repressed Liver Qi, or to an inability to contain what there is - however little - due to
Liver Qi deficiency.
Lesson Eight 6
© Leon I. Hammer, M.D.
as in the lower portions of the organ depths, reflecting retained pathogens. Traditionally, the
Choppy quality has been viewed as a form of Blood stagnation. The Chinese medical concept of
Blood stagnation is analogous to blood clotting, which obviously becomes a threat to health and
life if blood stagnates/clots to the point of insufficient circulation.
Given the enormous increase in the number of appearances of this quality on the pulse,
practitioners of Contemporary Chinese Pulse Diagnosis (CCPD) have explored the relationship
between Blood stagnation (stasis) and toxicity. Blood stagnation, in many cases of toxicity, is a
result of the failure of metabolic Heat to eliminate a toxin, usually from the Liver. If Heat cannot
perform its function of elimination, it accumulates and becomes dangerous Excess Heat in the
Liver. While the Liver normally tries to eliminate Excess Heat through Bile into the Gallbladder,
the system can become overloaded. When this occurs, the Excess Heat is eliminated into the
Blood stored by the Liver. Overtime, this Heat dries the blood vessels walls (such that they
gradually lose their flexibility) and coagulates the blood, which slowly loses its Yin component.
The Choppy quality is associated with this coagulated blood.
It is of particular interest that, increasingly, the Choppy quality is being found during the initial
overall Uniform Impression that is made whilst taking the pulse on both wrists simultaneously, at
the onset of the examination. We take this Uniform Impression in order to get a sense of the
qualities that are uniform over the entire pulse (all three positions on both sides), and on other
large segments of the pulse (such as the Triple Burner). Qualities found over the entire pulse
have special significance to diagnosis, and are interpreted differently than when they are found
in one position only; over the entire pulse they give us a picture of systemic, rather than
localized, pathology.
For example, Rough Vibration felt simultaneously with all six fingers indicates a previous shock
to the Heart, whereas were Rough Vibration found in any individual position only, it would
communicate tissue damage to the organ associated with that particular position. As such, the
Choppy quality found in any singular positions might mean localized toxicity, Blood stagnation,
or micro-bleeding (in the case of the gastro-intestinal system), but when felt initially in all six
positions, Choppy signifies systemic toxicity.
At first, the association of the Choppy quality with toxicity and its implication of blood stagnation
puzzled me, until I researched the effects of toxicity and discovered that many toxins kill by
causing massive blood stagnation. The subject is more than worthy of further intensive
research.
We used to find the Choppy quality rarely during the initial Uniform Impression; in recent times it
has become very common. This indicates not only systemic toxicity, but also retained
pathogens, known as “residual pathogenic factors”. This toxicity is linked to extensive and
excessive use of oil-based hydrocarbons, and to organophosphates. We have seen a Uniform
Choppy quality in Gulf War veterans suffering from Gulf War syndrome, and in the normal
population, with their ever-increasing and ubiquitous exposure to hydrocarbons and chemicals
in plastics, pesticides, herbicides, cosmetics, clothing, drugs, etc. It has been estimated that,
compared to sixty years ago, there are over 200 new synthetic chemicals in our blood; these are
mostly short- and long-chain hydrocarbons from oil-compounds and plastics. (These
Lesson Eight 7
© Leon I. Hammer, M.D.
hydrocarbons attach to endocrine receptors, and account for the astounding increase in height
that has taken place in the general population over the past forty years. We are now finding
young people physically larger, but internally weaker, than in previous generations.)
Lesson Eight 8
© Leon I. Hammer, M.D.
Leather-Hard quality in people exposed to known sources of radiation, especially in patients who
have undergone radiation as a treatment for cancer. It is from these patients that we have
extrapolated the radiation association to the growing prevalence and prominence of Leather-
Hard in the general population.
The Leather qualities are variations of the Tense quality, with very different interpretations. There
are three known variants of Leather, all of which feel similar at the Qi depth of the pulse - the
most superficial part of the pulse below Floating (which itself is just under the skin) - and vary
considerably in sensation at other depths. These three are Leather-Hard as discussed here,
Leather-Empty (associated with a Qi Wild condition), and Leather-Hollow, associated, as we
have seen, with severe hemorrhage. Leather-Hard is, unlike the other Leather qualities, a sign of
extreme deficiency of Yin, Blood, and, perhaps more importantly, Essence.
Li Shi Zhen placed the Leather quality in the Floating category, as more Wiry and Rapid than a
Hollow pulse. He stated, “The Leather pulse occurs from Cold and deficiency, or from when
perverse Qi moves internally; the Leather pulse results after severe damage to the Jing-Essence
of men, or after severe blood loss in women.”
The distinguishing aspect of the Leather qualities is their extreme hardness, especially at the Qi
depth. They have the same relative width as the Tense quality, less width than Taut, and greater
width than Tight. In the case of Leather-Hard, the other depths of the pulse are equally hard,
however in Leather-Empty, the Blood and Organ depths are diminished and Separating, and in
Leather-Hollow, the Blood depth is absent, as we learned earlier.
Until recent times, the Leather-Hard pulse has been a very rare pulse to encounter, and has been
found only in patients with known exposure to radiation. It represents such severe deficiencies
of Yin, Blood, and Essence, that its increasing presence in the general population - especially
the young - is extremely worrying. We are encountering the concerning results of our urbanized,
21st century life, and the disturbing consequences of an insidious, ubiquitous, and distinctly
modern pathogen.
In the past week, I took the pulse of a forty-five year-old, very tall Asian gentleman with whose
complaints I was unfamiliar. Due to the extraordinary thinness of his pulse I knew from the first
moment of our contact that he was seriously chronically ill: such is the significant implication of
such thinness in a man’s pulse. Then, throughout his entire pulse, again from the ‘First
Impression’, I found the Leather-Hard pulse. I learned that he is a computer engineer; this would
account for some of the occurrence of Leather-Hard, but clearly this man was vulnerable to have
the quality to such an extent of the entire pulse. It transpired that he had barely survived his
mother’s very precarious pregnancy and repeated threatened miscarriages; she herself had life-
threatening illness.
It would seem that Leather-Hard is the new Choppy in terms of its growing incidence, reflecting
the substantial impact of our Lifestyles and artificial environment on our health. Given its nature
of such profound deficiency, Leather-Hard will also reflect another subset of the ‘Nervous
System Weak’ condition, wherein patients experience fluctuating symptoms, are highly
vulnerable, unstable, easily disturbed or stressed, and have a strong vulnerability to illness. The
gentleman described above is extremely anxious.
Lesson Eight 9
© Leon I. Hammer, M.D.
Although other factors - Lifestyle, birthing issues, excessive exercise - can deplete Blood, Yin,
and Essence, never before has the Leather-Hard quality been seen except in people exposed to
radiation for cancer, and now to such a degree in so many people.
It is increasingly clear that the consequences of this extraordinary rise in radiation exposure are
now manifesting, not only as signs of deficiencies, but also as increases in toxic Heat in the
vessels. This all results in an acceleration of the drying and destruction of body tissues similar to
that seen in those undergoing radiation for cancer. We are now encountering pulse qualities
(Ropy, Leather-Hard, Robust Pounding, Slippery, and Choppy) in young people associated with
the arteriosclerotic process: something previously encountered only in patients in late-middle- or
old-age.
Treatment with acupuncture and herbs is, as always, beneficial, but without a radical change in
the way we live, we are merely treading water (if that). It is absolutely critical that we all limit our
exposure to EMFs as much as possible.
Lesson Eight 10
© Leon I. Hammer, M.D.
I end this Lesson with a general herbal formula used for treating patients exposed to radiation. I
have used it successfully many times to help patients with cancer counteract the negative
effects of radiotherapy. As useful a formula as it is, I must stress that, as ever, it is only to be
used after a full examination and diagnosis have taken place, and partitioners must always bear
in mind their patients as individuals.
Anemarrhanea Zhi Mu 20
Lesson Eight 11