© Leon I. Hammer, M.D.

LESSON TWELVE

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

When we consider the modern world, potentially one of the most relevant concepts within Dr.
Hammer’s work is known as ‘Qi Wild’. In simplest terms, Qi Wild is a systemic separation of yin
and yang; one of the most worrying aspects of this condition is how frequently it is now seen in
modern practice. This Lesson begins an introduction to Qi Wild
theory, presenting an outline along with potential etiological
pathways for the development of the systemic separation of yin and “Silence the angry man with
yang. As this subject is vast, future Lessons will expand upon the love. Silence the ill-natured
understanding behind the theory, and discuss how to recognize the man with kindness. Silence
separation of yin and yang in individual Organs. Later Lessons will the miser with generosity.
also address the signs associated with the systemic Qi Wild Silence the liar with truth.”
- Buddha
condition, and how to manage these disorders in patients.

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The Premise
Our primary goal, through the introduction and discussion of the issues that follow, is to raise
awareness in the acupuncture community of the role of the Separation of Yin and Yang and the
Qi Wild condition in life-threatening illness, and thereby enhance the prevention of severe
chronic disease.

In Chinese medicine, yin and yang are terms with multiple usages, but most relevant here is the
concept that yin is substance, and yang is function. All life depends upon the coherence of yin
and yang, and any separation thereof is a threat to life. To maintain coherence, we need the
ability to recover it repeatedly amidst our continuous homeostatic adjustments to moment-to-
moment stresses, as well as during the many instances of trauma, disease, and disharmony that
we all face. The ability of a physiological system to return to normal and maintain homeostasis
amidst the endless challenges of life is something I refer to as Stability.

A lack of Stability in the face of an onslaught of challenges to homeostasis inevitably leads to

chaos within the organism - to a situation where substance is no longer imbued with function -
because substance and function are separated.

We must be aware of the strong impact that such a situation has upon the health and survival of
our patients. We need to be familiar with the pathogenesis, and with the signs and symptoms by
which the separation of yin and yang is recognized. It is also vital that practitioners understand
the management of these conditions, at least to the extent that it is possible to generalize.

Deficiency, Excess or Stagnation of substance or function are signs of an on-going pathological

condition, and are concepts with which all practitioners are familiar. However, in the assessment
of a patient and the development of a management plan, signs of instability override the more
familiar signs, because instability reveals that a pathological condition has reached a stage of
dangerous dysfunction, and that the patient requires immediate, and sometimes even heroic
intervention.

Prior to major debilitating illness and death, the principal signs of dangerous instability are found
largely on the pulse, with qualities that we individually call the ‘Separation of Yin and Yang’, and
collectively call ‘Qi Wild’ or ‘The Qi is Wild’.

According to classical Chinese medicine literature, the Separation of

Yin and Yang, and what I refer to as Qi Wild, are encountered with
impending or actual death. However, the “slings and arrows of
outrageous fortune” begin with conception and, except in those with
exceptionally good luck, continue in varying degrees throughout life.
The reality is that the Separation of Yin and Yang begins in-utero,
wherever there is a significant enough deficiency of yin and/or yang to
lead to their separation, when yin (substance) is unable to control yang
(function). Yang out of the control of yin is chaos, and chaos is the
greatest danger to survival, wherever it is encountered.

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© Leon I. Hammer, M.D.

The Common Thread

There exists a common thread between many of the chronic conditions that confound both the
conventional and the alternative medical communities. I call this common thread ‘the Separation
of Yin and Yang’.

This separation begins with four factors:

The first is an attack by a Pathogenic Influence; this influence can either be internal or external,
and it can either be from nature (Cold, Heat, Damp), or from man (toxicity, trauma, emotional
and/or physical stress).

The second factor is the person’s ‘body condition’; this is partially determined by ‘constitution’,
and partially by life experience.

The third is the person’s behavior during and after the attack by the Pathogenic Influence, in
terms of rest or work beyond his energy.

The fourth is location: the Organ System or area of the body in which the Pathogenic Influence
has the strongest impact. This final aspect is intimately linked to the second, in as much as the
location is most likely to be that part of the person that is most deficient, and therefore most
vulnerable.

When all the four factors, described above, combine to create a favorable environment for the
success of an invasion by a pathogenic factor and the development of pathology in any yin
Organ, chronic diseases will develop. The final stage in their development always involves the
partial or complete separation of yin and yang. This can be seen in such diseases as the many
varieties of chronic fatigue syndrome (including food and chemical allergies of varying degrees of
severity), rheumatoid conditions, fibromyalgia, tuberculosis, HIV and AIDS, auto-immune
diseases such as lupus, multiple sclerosis, and other degenerative diseases, including
neurological conditions such as Parkinson’s and ALS, and cancer.

How it Happens
There can be several pathways via which a Pathogenic Influence may become chronic illness.
One of these routes is directly to the most deficient Organ system. Whereas the Lungs may be
most common yin Organ affected, for example, by a Wind-Heat invasion, it is worth
remembering that this External Pathogenic Factor attacks the most significantly-deficient Organ,
whatever that Organ may be. Of course, the symptoms and signs will vary according to the
function of that particular Organ, but the process will follow a series of steps we shall discuss
later. To demonstrate the direct pathway, let us take an example from my practice.

With this gentleman, his Kidneys were the most vulnerable Organ system. The invasion by a
Pathogenic Factor occurred when everyone in his family developed the flu while on vacation. He
had been overworking prior to that vacation for some years, and had recently lost a stressful
custody battle for his son from a previous marriage. He subsequently discovered that this son
was sexually abusing his other, younger son from his second marriage. While he was caring for
his sick family, he was suddenly struck by meningitis. For one and one half years from that time
until I met him, he would become extremely ill with pneumonia, following even the onset of a
slight cold.

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© Leon I. Hammer, M.D.

When I met him, he was exhausted and suffered from a deep chill in his spine. A detailed
examination revealed his Kidney Qi and Yang-Essence as the central energy deficits, currently
and constitutionally. The invading External Pathogenic Factor attacked his most deficient
system, the Kidneys: the Organ system responsible for the integrity of the medulla and the rest
of the central nervous system, as well as for some of the immune functions of bone marrow.
When the Kidneys are the most vulnerable Organ, then meningitis or encephalitis can occur
quickly at the stage of Excess Heat, and chronic, debilitating conditions may follow. In terms of
the Four Levels, this would be a case of the pathogenic factor skipping the Defensive and Qi
levels, and going straight to the Nutritive-Qi and Blood levels.

Pathways involving a more gradual progression from Pathogenic Influence to chronic illness
have been postulated since ancient times. These include the Six Stages of the Shang Han Lun
for pathogenic Cold, the Four Levels of Dr. Ye Tianshi for pathogenic Heat (as described in the
case history above), and the Triple Burner System largely for the pathogenic Damp of Dr. Wu Ju
Tong.

The final outcome of each of these processes is the ‘Qi Wild’ condition, where the deficiency or
disorganization becomes so profound that the yin and yang of the entire organism separate.

‘The Qi is Wild’
Qi Wild is a condition of extreme weakness of
substance and/or function wherein, for one
reason or another, yin and yang have lost
operative contact, and are unable to support
each other. The result is profound physiological
disorganization and chaos. Either the yang is
too weak to provide function and transformation
to the yin substance, or the yin is too weak to
nurture and control/contain the yang, or both.
Yang Qi is expansive, and is held in check only
by the centrifugal force of the more substantial
yin Qi (yin, Blood, and Essence). When yin loses control of yang, the latter becomes
ungovernable. Yin - the material energy of the universe - can be thought of as a gravitational
force that holds the more effervescent yang energies, and which when drained, can no longer
serve that function. Under these circumstances, the lighter yang energies wander aimlessly and
disruptively to all vulnerable parts of the organism, unable to function effectively without the
organizing forces of yin.

The pathogenesis of this Qi Wild state is that yin Organs that are severely depleted by
deprivation and cannot support yin, Qi, and Blood. In each affected yin Organ system, the yin
and yang separate due to this deprivation. Gradually, this process expands to the entire
organism, until the Qi Wild state is dominant. The physiological aberrations caused by Qi Wild
result in severe and unpredictable forms of disease such as cancer and other autoimmune
disease, and profound mental illness, depending on existing vulnerabilities. Unless the condition
is corrected, the prognosis for a long or productive life is poor.

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© Leon I. Hammer, M.D.

The most serious form of Qi Wild is one that is caused by an environment - at conception, in-
utero, at birth or in early life - marked by severe nutritional deprivation, drugs, and inadequate
shelter from the elements. We would expect this to be ubiquitous today in the countries of the
third world - especially Africa - racked by war and starvation. However, children throughout the
world are hungry, including those in the United States. The Qi Wild pulse can also be the result,
especially in vulnerable young people, of overwork, over-exercise, excessive lifting, sudden
stopping of extreme exercise, extreme prolonged emotional and physical abuse, and substance
abuse. The symptoms and signs will vary widely depending on the severity of the patient’s living
conditions, his age at onset of the condition, the time elapsed and any subsequent remediation
since the onset of the condition. It is probable that the more serious the quality is, the earlier the
etiology occurred.

History
The concept of ‘Qi Wild’ is not included in the normal Traditional Chinese medicine curriculum.
In fact, some practitioners reject it outright. Except for in the works of Porkert, Li Shi Zhen, Jiang
Jing, and in the Nei Jing, I have found nothing substantial about the Qi Wild condition in the
English language literature: when it has appeared, it is only as the final separation of yin and
yang at death. Nevertheless, it is one of the most important aspects of Chinese pathology; it
involves an entire range of disharmony and pathology that is rampant in our time, and is
something of which many practitioners are unaware and therefore unprepared to diagnose and
treat. It is the ultimate consequence of the Jue Yin phase mentioned in the Shang Han Lun, and
the Blood level of the Four Levels.

Porkert refers to the Qi Wild condition at least twice. The first is in his discussion of the Flooding
quality, which he associates with “profuse Heat”. He also describes Flooding as a sign of
deficiency and “grave danger” if it “persists for some time” during convalescence following a
serious illness; he fears this time is a period of “dissociation of active and structive energies”.
This corresponds to what Dr. Shen describes as the Qi Wild dissociation of yin and yang.

Porkert's second reference is in his discussion of the Racing pulse: “an extremely excited and
accelerated pulse attaining seven to eight beats per respiration in the adult”. He goes on to say,
“After a collapse of the yin, the yang, having lost its foundation, is mobilized in the extreme: a
symptom of the imminent collapse of the Qi primum.” He explains further that the Kidney
Essence is exhausted such that, “consequently, yang active energies disperse uncontrolled. At
the same time, it is a symptom that this yang, this active energy, has already been greatly
depleted or is about to be depleted...”, and that if it is a accompanied by a high fever “…it must
be considered a very serious symptom.”

Li Shi Zhen discusses the separation of yin and yang, but he does not make it clear whether or
not he is talking about pulse qualities that involve the entire organism or just one organ when he
says, “If the pulse beats only at the chi position and is unable to reach the guan position”, and
“If the pulse beats only at the cun position and is unable to reach the guan position”. He does
say that “…in these two diseases the ‘yin and yang separate’”. Other pulse qualities similarly
implicated in this separation are “deep, hidden and intermittent” in that the “entire body is in
danger of breaking down”. He mentions that when the pulse is “floating and scattered, but has

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© Leon I. Hammer, M.D.

no root: it cannot be felt under heavy pressure,” it is a sign that “the entire body is already
suffering from severe damage.”

Detection
Prior to major debilitating illness and death, the principal signs of dangerous instability are found
largely on the pulse: there are pulse qualities that indicate the Separation of Yin and Yang within
individual Organs or areas of the body; and there are pulse qualities that collectively are a sign
the separation of yin and yang has become systemic, or as Dr. Shen would say, that ‘the Qi is
Wild’. Some of the pulse qualities that follow have been described in previous Lessons; the
others are described in my books on pulse diagnosis.

Pulse Qualities Associated with a Qi Wild Condition

The most serious Qi Wild pulse qualities are Empty Interrupted-Intermittent, Yielding Hollow
Interrupted-Intermittent, Empty, Yielding Hollow, Leather-Empty and Thread-Like, Scattered,
Minute and Changing Qualities. To qualify as pathognomonic of a Qi Wild state, the quality must
appear on the entire pulse (all six positions on both wrists at the First Impression) or in at least
four of the six Principal Positions. 

The Muffled quality can be a sign of cellular chaos. When it appears to a great degree over large
areas of the entire pulse, then such a finding must be considered an indicator of the Qi Wild
condition. Similarly, when the pulse of an individual Organ has a very high degree of the Muffled
quality (graded at 5, out of a possible 5) then it is a serious sign of the separation of yin and yang
within that Organ.

Pre Qi Wild Pulse Qualities

The Very Deep, Very Feeble, and Absent qualities are signs of extreme Qi to Yang deficiency
which, though not pathognomonic of a Qi Wild state, lead to one within an unpredictably short
time if they are not corrected.

Eyes
The light shining from the eyes is a sign of the state of the Shen, or Spirit,
of the organism. Spirit in this instance is a concrete expression of the
basic energies of the body, especially of the Zang organs, and not an
esoteric concept. The light, or lack thereof, in the eyes will vary with the
different etiologies and manifestations of a Qi Wild condition. 

For example, the Qi Wild condition associated with severe psychiatric
conditions is sometimes accompanied by a scattering of light flashing
wildly from the eyes, and is pathognomonic of such severe mental-
emotional chaos.

Tongue
Dr. Shen taught, and I have observed, that in some patients with Qi Wild pulses, the tongue has
a flabby, milky-white appearance, with loss of a balanced, coherent shape and, in some

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patients, a total loss of color towards the front. Sometimes this loss is continuous, and in others
it is sporadic. This is usually concurrent with extreme fatigue and enfeeblement, even (and
increasingly) in young people.

For the Future

This has been a very brief introduction to a subject, one designed to hopefully open awareness
to a concept most practitioners associate only with death. A separation of yin and yang and a
subsequent Qi Wild condition may well ultimately result in death, however, these conditions can
be energetically present many years before the end of life. The separation of yin and yang can
begin in-utero, and can also develop during all stages of life. The ability to recognize them
provides the practitioner with an incredible opportunity for the prevention of serious, life-
threatening diseases. For this reason, in future Lessons, we shall return to the concepts
introduced here. I feel that as the world continues to change, and acute conditions give way to
chronic illness as the main category of problems faced by modern practitioners, an
understanding of the diagnosis and management of the separation of yin and yang becomes
disturbingly relevant to anyone practicing Chinese medicine.

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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