I am happy to have my very first guest post here on CMNotes!
I am very happy that the first guest post is about a very important subject in Chinese Medicine- the pulse.
Ross Rosen is a very busy man and I was thrilled that he found the time to write about his experience with Dr. Leon Hammer, an interesting practitioner in Chinese Medicine.

The post reminded me of this one session with my healer and mentor, who told me that my pulse is like “riding horses”.
This might explain the attached photo.

I’m glad to say that this is an interesting post, which made me curious to know more about pulse diagnosis.
I hope it will do the same for you.
Enjoy!

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Chinese pulse diagnosis is the hallmark of Chinese medical diagnostics.  I have been intrigued by it as long as I can remember.  As a student learning Chinese medicine, one can’t help but feel so disappointed in the lack of training received in this art and science.  For me, it was an unbearable frustration that led me to seek out and study with Dr. Leon Hammer.  In Chinese medical school I was exposed to Dr. Hammer’s Dragon Rises, Red Bird Flies and some of Dr. Hammer’s articles from www.dragonrises.org and knew instinctively that this would be my teacher.  Looking back now 10 years, I am honored to call Dr. Hammer my teacher, mentor and dear friend, and was excited when Yael asked me to author a blog post on my experiences with him and his teachings.

What may shock people is that when I think of my experience with Dr. Hammer, my training in pulse diagnosis is not the most important thing I learned.  What I am most impressed with and most try to emulate is Dr. Hammer’s ability to understand his patient’s suffering and perception of his/her illness, his ability to make contact with patients and enter into a sacred therapeutic relationship.  The pulse is a tool for this process and informs the diagnoses, and acts as a catalyst or jump start in the formation of this healing relationship. 

Most practitioners who are aware of Dr. Hammer generally think of pulse diagnosis, and for sure, this is a tremendous area in which he has contributed to the medicine.  I will speak more on this in a minute.  But what people are unaware of is an entire body of knowledge that Dr. Hammer has synthesized into what we call Contemporary Oriental Medicine, or COM.  COM is a dynamic, integrated model of diagnosis and treatment based on the experience of Dr. Hammer which at last count includes over 80 unique concepts not included in TCM. Concepts that reflect the realities of Chinese medicine as an evolving medicine relevant to the present day and age.  Such concepts include: birth traumas and Heart shock, toxicity, Liver qi and yang deficiency, the separation of yin and yang as precursors to significant and debilitating illnesses, etc.
COM includes an in-depth diagnosis focused on Contemporary Chinese Pulse Diagnosis (CCPD), as well as the concepts and diagnostics included in Dragon Rises, Red Bird Flies Chinese medical psychology. It is a completely unique method of evaluating the patient’s condition, diagnosis, and intervention based on critical thinking and leads to an organized hierarchy which identifies root causes, immediate interventions, derivative and secondary issues, referrals, life style counseling and treatment methods.  Some of how these concepts play out can be seen in the following article:  http://www.chinesemedicinetimes.com/section/254/1/an_introduction_to_contemporary_chinese_pulse_diagnosis
As for CCPD, it is impossible to capture the complexities, subtleties and profoundness of this method of diagnosis in a blog post.  We explain CCPD as an exquisite and sophisticated means of understanding the whole person and provides insight into patients according to:
the patients’ constitution
previous illness
early insults to normal physiology
environmental stressors
traumas
effects of lifestyle
emotional conditions
behavioral patterns
CCPD relies on the subtleties of the sensations, qualities and structure of the radial artery at both wrists.  It is a complex system that synthesizes information from the combinations of various qualities felt at the 6 principle pulse positions and the 22 complementary positions, as well as the qualities perceived uniformly over the entire pulse and at each of the requisite depths (8 of them). Integrating the information from these seemingly disparate parts, one is able to arrive at a complex diagnosis, which prioritizes levels of imbalances of not just the symptomatic representations, but more importantly the root causes of disease.
CCPD can diagnose the subtlest changes in physiology making it invaluable as a preventive tool.  It has the most sophisticated measure of a balanced healthy condition and detects the process that is moving one away from this baseline.  I refer those interested in learning more to the Dragon Rises Seminars website at http://dragonrises.org.  There is a wealth of articles written by Dr. Hammer as well as myself and my colleague Brandt Stickley.

When taking someone’s pulse, there are a few things to keep in one’s mind.  First and foremost is what the Normal pulse feels like.  Without this understanding, it becomes impossible to perceive deviations from this.  The Normal pulse:
1.    has a consistently regular rhythm
2.    has a rate that is consistent with age
3.    is compressible, resilient and elastic
4.    is long, smooth and continuous without turbulence           
5.    is moderate in strength
6.    is balanced between superficial, middle and deep depths with the most substance at the deepest or Organ depth and becoming lighter as one ascends to the Qi depth.
8.    is balanced between positions with the middle position occupying the most space
9.    has a stable Intensity (buoyancy, elasticity and resilience of the pulse) and Amplitude (height of the pulse)
11.    has qualities which are stable and consistent over time and
12.    has a Wave reflecting a Sine curve that begins at the Organ depth and gradually rises to the Qi depth, and then subsides again to the Organ depth.

With this checklist of a dozen characteristics, it really informs about what to be on the look out for.  Deviations from this Normal pulse is significant wherever it is found.

Another very important aspect of pulse diagnosis is methodology.  CCPD is practiced in a very specific way:   First, the rate and rhythm are taken followed by the uniform qualities felt over the entire pulse (this means with all six fingers over the pulse positions; three on each wrist).  This provides the grossest level of information that the body is trying to convey; things that are happening systemically.  By treating based on these messages alone, one can achieve significant results for one’s patients.  In addition, keeping in mind these diagnoses while interpreting the rest of the pulse picture and treating accordingly can provide profound improvement.

After evaluating the uniform impressions, one takes a look at each wrist individually.  Interpreting the left side by itself and what it represents (the organ systems) and then the right side (the digestive system) can provide additional useful information.  Next, one palpates once again with both hands on all pulse positions and examines the 8 depths.

The next stage is to assess the pulse wave and how the pulse rolls over the pulse positions.  There are 5 major waves which we analyze, again, each with differing messages being conveyed.  They are:  Normal, Hesitant, Flooding Excess, Flooding Deficient, Full-Overflowing and Suppressed.

Lastly, the 28 pulse positions (6 Principle positions and 22 Complementary positions) are palpated to narrow the focus and perceive messages from the individual organ systems and areas of the body.

In this way, one does not lose the forest for the trees or vice versa and is able to see the larger picture and the individual parts simultaneously and synthesize this information into a complete health picture.

Another crucial aspect of pulse diagnosis is to not expect pulse qualities to be so obvious.  One of the things that I am constantly amazed at is the subtlety of the pulse qualities and the need to sit with it, pay attention and trust what one feels.  The qualities can change while accessing them and to be able to sit long enough in a position to determine this is important, especially as Changing Qualities is a very significant finding that signifies a Separation of Yin and Yang and/or Qi Wild condition.  (see http://www.chinesemedicinetimes.com/section/275/1/the_separation_of_yin_and_yang___part_one and http://www.chinesemedicinetimes.com/section/293/1/the_separation_of_yin_and_yang___part_two for a detailed discussion of this topic)

The other significant aspect of feeling the pulse is to make sure one is in the proper position as well as accessing the principle impulse.  Often the inability to feel the proper quality and hence message the body is trying to convey is due to being in the wrong position or not having one’s finger directly over the principle impulse on the artery.

When done properly and expertly, pulse diagnosis yields the most incredible information; so much information that it can seem overwhelming initially.  This is truly one of Dr. Hammer’s gifts; being able to interpret, synthesize the seemingly disparate parts of the pulse and one’s physiology/pathology into a coherent and brilliantly perceptive list of diagnoses that includes one’s psychological root imbalances and adaptations.  As a psychiatrist in addition to practitioner of Chinese medicine Dr. Hammer is particularly astute in this regard.  From the pulse alone, one can diagnose a significant amount of psychological characteristics, such as anxiety and panic, depression, feelings of resignation, anger, grief, vengefulness, obsessiveness, confusion, etc.

Diagnosing and understanding the psychology of the patient becomes important and to some degree is really the essence of what we aim to understand in order to more completely help our patients.  To understand the root of one’s emotions and lifestyle and habituations and to counsel our patients to make the necessary connections and corrections is practicing Chinese medicine at it’s highest potential.  It is about engendering awareness.  This is the essence of what Dr. Hammer teaches with his unique gifts as both a skilled psychiatrist and practitioner of Chinese medicine and diagnostician. 
 
It is a privilege to have studied and continue to study with Dr. Hammer, to be one of the certified teachers in CCPD, COM and Dragon Rises, Red Bird Flies and to be a colleague whereby I make my own contributions to this system of medicine and diagnostics and carry forward this information towards the future.  I welcome any comments or questions regarding my experience with Dr. Hammer or CCPD, COM and Dragon Rises, Red Bird Flies.  I can be contacted through my website at http://www.acupunctureandherbalmedicine.com or centerforacupuncture@gmail.com

Ross Rosen, JD, MSTOM, LAC, CA, DIPL OM (NCCAOM)