By Leon Hammer, MD
First published in The American Acupuncturist, Fall 2007, Volume 41
Abstract: Awareness – awakening – is the single most important quality of life to healing and growth in all therapeutics, religion, and philosophy, since the beginning of recorded history. It is central to the changes we must contemplate in terms of healing for both patient and practitioner. Chinese medicine has a great deal to offer through its diagnostic and treatment modalities in service to this critical goal.
It is said that God is not interested in peace, only clarity. This was Avatar Meher Baba’s message when he proclaimed silence and said, “I have not come to teach, only to awake.”i In Zen Buddhism, the focus is on the here-and-now, as it was with Gestalt Therapy developed by Fritz Perls. Freud’s objective with psychoanalysis was to make the unconscious conscious, and the Jacob’s ladder of the Kaballah is one of increasing awareness.
Enhancing awareness has been the center and focus of every esoteric religion, the central issue of science, and the central goal of psychology. The central concern of existentialism is “How awake is this person to the life inside and outside of themselves?” asks Albert Camus in The Stranger.ii
Nevertheless, even awareness requires caution for it is said that one does not dare desire the impossible in full awareness, without being psychotic. I have seen this happen to neophyte meditators isolated in monasteries of various religious persuasions.
It is my thesis that safe awareness is the primary goal and potential accomplishment of Chinese medicine. Indeed this is the opinion of most of the patients I have encountered therapeutically in the past thirty-six years. The awakening is in all areas of life from the most intrinsic knowledge of self to changes in lifestyle.
In one of my nine month courses on Asking Diagnosis, I recommend to my students that they have several posters on the walls of their future office. One would say: “Terrain and Stress” (Is it the bacteria [stress] or the body condition [terrain])? The second would say: “Vulnerability, Vulnerability, Vulnerability.” The third would say: “Diagnosis, Diagnosis, Diagnosis” and the fourth “Management, Management, Management.” The fifth, in the largest letters of all and most prominently placed, will be a sign that says: “AWARENESS, AWARENESS, AWARENESS.”
II. Aware of what?
The question arises, aware of what? In an excellent paper, Lonny Jarrett iii argues that the awareness is one of choice that overrides the ego concerned with only itself in the space occupied by fear (water) and desire (heart), and responds only to the “unchanging authentic self” that has universal concerns. He states “Simply put, freedom means `free to choose’ as opposed to being a slave to the mechanism of a conditioned mind.”
Freedom of choice is an issue that leads down many thorny roads filled with more questions than answers.
One is Sullivan’s definition of neurosis that condemns people to repeat the same behavior and thought patterns despite their maladaptive nature. The goal of all interventions ascribed to as therapeutic has been to break that cycle, one that I address with regard to Chinese medicine in section V of this paper.
The second is the dilemma of the “individual.” I consider Chinese medicine unique in its ability to provide the tools to delineate one individual from another, whatever the CF, Sho, or other ascribed condition (to be discussed in detail in another context). It seems as if Jarrett is saying we need to be aware that we can make a choice. That may be true but who would agree on what is “universal?” The religious right and people who deny global warming would not agree on that definition from Jeffersonian deism and tree huggers like myself. One could argue that these are not “universal” but ego-driven values.
This also raises the question, how do we achieve the state of egolessness required for a choice based on universal awareness rather than ego driven values?
A third issue discussed in greater detail elsewhere is that of containment to which Jarrett alludes as necessary to make a choice. I believe that containment is a major and natural necessary function of the Liver in the service of making choices of behavior throughout life, and is the positive aspect of Liver qi stagnation. I would argue that there is too little Liver qi stagnation in our time, not too much, and that the inability to bear the pain necessary to maturity, what Campbell meant by “life” (see below), is a major Liver qi-yang deficiency due to the cold substances universally used in our culture. Containment with Liver qi-yang deficiency is impossible, and containment is necessary to hold an idea until it can be sufficiently considered to lead to a thoughtful choice (plan and decision or direction).
I argue that the goal of what all esoteric religions and sincere therapeutics mean by “awareness” has always been what Jarrett calls the “unchanging authentic self,” and that behavior towards the larger world (your neighbor) is also an unchanging measure of that achievement. Eric Frommiv in his eulogy to Harry Stack Sullivan at Carnegie Hall in 1949 mentioned that cultures are ultimately measured in history by how the powerful treat the powerless (Sullivan literally gave his life for this).
The pursuit of the genuinely spiritual has been desecrated by “new age” spiritualism that embraces the easy road to nirvana through drugs and weekend workshops. These are only ways to avoid the pain that takes a lifetime to experience before we reach even a modicum of wisdom if we want to equate that with enlightenment.
Joseph Campbellv relates a story in which a group of young American neophyte Buddhist priests dressed in saffron robes visit him with the message that he has been wasting his life exploring religions and myths and that he should follow them because they have found the “way.” After their endless entreaties he congratulated them and said that there was one small sticking point. When asked, “Man, what that could be?” he answered, “life.”
It is also interesting that Jarrett measures spiritual achievement by behavior and not by feeling, with which I entirely agree. What ‘feels good’ is not always good. This is at the heart of the Hebrew ethic. Spirit in the Hebrew tradition has always measured by what you do, not how you feel.
Lastly, on the subject of “aware of what” I would add[jlb1], without elaboration here, that we need the capacity to be fully aware of the great unknown of our existence, our ultimate insecurity, who and where we are; and this without the artificial refuge of the many bearings of power.vi
III. Practice of CM is the Practice of Awareness Our senses are our primary tools of awareness.
In 1919 William Oslervii, the dean of Western medicine wrote, “Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone can you become expert. Medicine is learned by the bedside and not in the classroom. Let not your conceptions of the manifestations of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first.”
What do we do?
We ask and listen, especially with the “third ear,” not to what people say, but what they do not say, to what people avoid, and to what they want underlying the verbiage. We “look” with the “third eye” to see if body language belies words. We touch (pulse and palpation), smell, “feel,” and with our hearts we intuit and empathize. With our minds we receive, process with logic, and integrate. Some of these are discussed in “The Therapeutic Relationship”viii[w2]. Others will be covered in a forthcoming book on diagnosis other than the pulse.
IV. Heart Phase
The Heart plays the central role in awareness and in all aspects of human psychology. The spiritual force of the Heart is dominant in the development and function of all the other energetic forces related to the mind, spirit, and soul. The Heart controls the mind: mind affects the Heart.
In Oriental terms, the key to subtle unspoken awareness is an open Heart; free of desire, craving, addiction and its pursuit. As Claude Larre and Elizabeth Rochat de la Valle wrote [w3][jlb4], “By nature man’s Heart is vast and free like Heaven; always tempted to fill itself, it must seek to become empty. An empty heart can receive.” What fills the Heart instead is desire, and craving interferes with awareness. Life is spoken of as a “rambling walk directed by the Spirits.” This “long life, everlasting vision and rambling walk” can be damaged. “ For life to be fulfilling one must allow the Spirits guide the Breaths through life.”ix
The Pericardium and Triple Burner acknowledge and express this awareness with words.x While the Heart is the emperor, the Triple Burner runs the empire. The water grounds us in the here-and-now. The wood provides direction. The metal, when healthy, provides flexibility. “The Earth Phase bears the milk of human kindness and fulfills the ‘basic need’.” This is the beginning of self-worth. The Heart yin is the medium which enriches that “milk” into the “cream” of human congeniality and fulfills the basic “want.” Here is the source of all joy.
In my book Dragon Rises-Red Bird Flies, I wrote that “Perhaps the most important consequence of the introduction of acupuncture into my practice was the flowering of awareness in my patients and my own appreciation of its significance to growth and development.”viii Awareness as mentioned above is the centerpiece of Zen Buddhism and is almost synonymous with the concept and experience of enlightenment.
The Heart fire energies are deeply concerned with “creative awareness and expression.” With regard to awareness I wrote further that “Heart yin inspires that substance [from Kidney yin] into awareness and Heart yang gives form to the creative idea[w5].. The dominance of consciousness and awareness, of creativity and love, by Fire energies places these energies in the center of all interpersonal considerations.”
“Also, in terms of consciousness and awareness, the Fire Phase contacts the general energy [Heart], distributes it fairly [Triple Burner and Pericardium], and purifies it [Small Intestine]. On the level of feelings, and at their supreme maturation, these energies nourish and govern the awareness and the expression of unconditional love, both for self and for others.”
Heart energies are responsible for the higher, conscious, intellectual mental “investigation of life” including: awareness, “symbol formation,” and the communication of ideas and feelings. The heart “opens” to the tongue and is embryologically close to the throat. There is a Hindu saying that “if one can close off the throat, one closes off the flow of thoughts.” The Heart controls the circulation of ideas within and between men.
“Only through these Heart yin energies do the Divine Spirit, Divine Love, and Divine Will [discussed elsewhere in relation to Kidney qi, yin and yang] come into conscious human awareness.” Divine revelation is the gift of Heart yin. A deficiency of Heart yin will manifest as a “lack of awareness and consciousness of the inner self”. An excess of Heart yin energies involve “a greatly enhanced awareness of both the inner chaotic world of the unconscious and the constantly impinging sensory and
emotional stimuli from the outer world.”xii Too much of a good thing is destructive.
All of the clinical issues mentioned below in the language and concept of Chinese medicine; phlegm, fire, deficient heat, trapped qi, qi and yang deficiency, closed orifices, blood stagnation all interfere with the ability of the Heart to fulfill its energetic function to maintain contact with and sustain full awareness of the outer world of interpersonal affairs as well as the inner mental, emotional and spiritual world.
Depending on degree of interference, as well as other variables such as constitution, shock, trauma, nutrition work, exercise and habits (drugs, sex, etc.), there can be a wide variation in the severity and the nature of symptoms associated with a loss of awareness due to an impediment of heart and other fire energies.
Almost all psychological disorders can be understood as a function of awareness either in quantity, quality (perception and distortion) and form. In fact, the Greek word for insanity is alienation, which is in fact a loss of awareness of what is coming to or from the inner world (boundaries).
The principal problems that attend human relationships fall mostly into the realm of communication. Fire energies are all about communication. Heart yang and Pericardium yang, Triple Warmer and Small Intestine energies as discussed in my book xiii are all involved in the appropriate and effective expression of thoughts and feelings. Where the clarity of communication is involved, all of the distortions attending maladaptive discourse are rooted in awareness. They are, therefore, also ineluctably rooted in the integrity of the Heart and Pire phase. Therefore, all human problems from marital and family conflicts to the most serious neurosis and psychosis are to some extent the manifestations of defects in fire energy performance. For more information regarding psychological disorders related to Heart function I refer you to chapter 15 in Chinese Pulse Diagnosis: A Contemporary Approach [pp. 547-8 and the glossary] and Dragon Rises Red Bird Flies, chapter 14 [pp. 316-319; 333-338].) (Another paper more closely examining the Fire-Heart Phase will be forthcoming.)[w6]
The herbs that are listed below are critical to that performance in combinations dictated by an accurate Chinese diagnosis of the “individual”.
V. Vicious Cycle
Prescriptions for enhancing awareness begin in our earliest history attested to by archeology and anthropology and by the history of religion and philosophy. The latest in this long line, which includes meditation of endless sorts, are the modern psychologies.
With regard to the latter, having studied and practiced this discipline for over fifty years, it was clear to me from the beginning that an intellectual exchange was insufficient to converting intellectual insight into true living awareness. My professional odyssey involved a search for a way to make that conversion that finally centered on touch but included LSD, when still available in pure form, as a therapeutic modality. The methods of touch that I encountered were all centered on the psychoanalytic concept of resistance embodied in the musculo-skelatal structure and usually involved an assault on that structure that I would equate with the modern “wars” on drugs and terror. This was a “war” on “resistance” that I observed only deepened rather than resolving it.
In Dragon Rises, Red Bird Flies, I reinterpreted “resistance” as simply maladaptive ways of maintaining “contact” in order to stay “intact.” Rather than “attack” it as “resistance” I found identifying the talent and differentiating it from the distortions was a more productive approach to maladaption. This was an improvement over the “attack” approach; however the tendency for maladaptive behavior in the face of insight and experience continued to be a challenge. The “vicious cycle” of stimulus and maladaptive response seemed difficult to break and defied all mental constructs and techniques. Some vital part of the cycle was missing from our theory and practicexiv.
Though Freud, Sullivan, and Reich all used energetic constructs in their theories and work, only the Orientals developed in detail what I found to be the missing link in the “vicious cycle.” That proved to be the energetic body through which the cycle traveled and was influenced, and that lay outside of Western psychological theory and practice.
In this paper I will discuss only one small but significant intervention in breaking the cycle, the link from insight to meaningful awareness. I am currently writing a book greatly enlarging the scope of this work that began conceptually and diagnostically with Dragon Rises, Red Bird Flies. It will include management and treatment illustrated with one case history per phase delineation [ex: Heart yin deficiency] typical of my experience.
VI. Orifice Opening and Related Herbs in Psychiatric Practice
This section concerns itself with the use of herbs to treat those psychological disorders that are rooted in the dysfunction of fire phase energies in synergy with each other. While the emphasis here is on the orifice (cavity) opening herbs, they cannot be considered in isolation from the accompanying etiologies and disharmonies that inevitably occur and the herbs which are used to treat them.
An important first consideration is the concept of the “orifices of the Heart.” According to Imgard Enzingerxv[jlb7], who has done extensive work in this area, these were traditionally identified roughly with the sense organs, the ears , eyes , mouth , nares  as the “outer orifices,” and the “inner orifices” as a metaphor for the outer. According to her, the latter were visualized in the “Yangsheng texts or tests of Inner Alchemy as `orifices’, `holes, ‘caves’, ‘gates’ or ‘passes’ ,” “experienced as a kind of inner sensation, however, there are no orifices on the visible or touchable body. Nonetheless they have the concrete task to control the flow of qi. In my opinion, the seven inner orfices are functionally existing, and in their function in terms of both shen and qi, they are not reduced to the blood vessels coming from and going to the Heart.”
The orifices associated with “phlegm misting” seem to be firmly associated with the concept of the “Heart controlling the mind” since treating this condition clearly affects the mind often in very dramatic fashion that I have catalogued clinically.
My teacher, Dr. Shen, claimed that he could identify on the pulse the three great vessels and four valves of the Heart. I can consistently feel the mitral valve, and I and others have confirmed many times the presence of mitral valve prolapse (by echocardiogram) with a Slippery quality(phlegm) in this position. In Western medicine a mitral valve prolapse condition has been associated with panic attacks and phobias since I entered the profession fifty-five years ago. Treating the condition with herbs that are indicated for removing phlegm from the Heart orifices leads to dramatic results. In fact, over the years, I came to treat most emotional-mental problems in this manner with good results.
This has led me to suspect that while these inner orifices may be metaphors of the outer ones, that the entire picture does involve something more concrete.
B. Clinical Considerations and Pathogenesis
In my practice I used these herb formulas to treat mild, moderate and severe mental and emotional disturbances. The principal differences were in the greater or lesser weight given to specific herbs and dosages in the total picture. In Western medical terms these would include neurosis, depression, bipolar disorders and schizophrenia.
In Chinese medicine the causes could be any combination of Zang-Fu disharmonies, pernicious influences and triple burner pathology. Chinese medicine has been successfully treating these conditions throughout at least two to three millennia without the Western classification because Chinese medicine at its best provides the diagnostic tools to treat an “individual” not a “disease.”
The distinction between constitutional, congenital, childhood and adulthood etiologies is also vital. Still, most important is an accurate diagnosis of the “individual” since the substances recommended for use in this discussion must be included in a matrix of treatment that accommodates the entire entity.
While orifice opening herbs were always a consideration in treating psychological disorders, phlegm removing herbs were included in my practice especially if Slipperiness was felt on the pulse, and especially at the left distal and/or mitral valve positions. Slipperiness on other positions such as the right distal, and both middle positions also warranted consideration if the tongue and symptoms were appropriate. A vertical center-line on the tongue with thick coating is a sign of phlegm in the Heart.
Over time I routinely found that including Heart phlegm removing herbs was valuable with all emotional-mental issues even when the signs described above were not clear. As with all conditions, they exist as a process even before the body-mind communicates it in the way of symptoms and signs.
The literature discusses phlegm-cold and phlegm-heat. The former is associated with schizophrenia and depression and the latter with mania. In fact the distinction is not clear, as I shall demonstrate.
Phlegm accumulates for several reasons, roughly classified as excess and deficient etiology. In either case the issue is stagnation, of qi and less often of blood. Stagnation can occur due to excess of qi (blood) or a deficiency of either or both. In the case of excess there is more qi than the heart can move and with deficiency there is too little qi (blood) to overcome the stagnation.
An example of excess stagnation in the Heart is with a shock to the Heart when the left distal position (heart) is either Flat or Inflated. This can happen in utero, birth, childhood (usually Flat) or at any time during life (usually Inflated). An example of deficiency creating stagnation would be any impairment of Heart qi or blood for any reason that interferes with the movement of either, through the Heart, Lungs, and chest.
The organism abhors stagnation and brings metabolic heat to move it, first from the organ itself and later from the general reserve. If the stagnation moves then there is no further concern. If the metabolic heat cannot move the stagnation the heat accumulates, a condition unacceptable to normal functioning, and the organism sends fluid to cool the heat. This consumes yin of the organ and later of the Kidneys. As the heat and fluid accumulate the heat congeals the fluid that we call “phlegm.”
Therefore, phlegm (heat and fluid) is always ultimately present with stagnation, and in all cases of “phlegm,” heat is involved whether the cause is deficiency (phlegm-cold) or by excess (phlegm-heat).
Ultimately all unsuccessful efforts to overcome stagnation lead to to qi and yang as well as yin deficiency for the reasons described. The final state of exhaustion is when the Heart yin and yang separate, leading to a severe state of chaotic functionxvi.
It is important to monitor the heat removing herbs in these formulas since their continuation after the heat is removed can weaken the qi and yang of the Heart. Likewise the damp draining and phlegm removing herbs will damage Heart yin if not carefully monitored. Excessive use of formulas such as Cattle Gallstone Pill to Clear the Heart (Niu Huang Qing Xin Wan) can damage Heart qi and yin.
Awareness is the critical attribute whose presence is the single most important factor in health and whose deficit is the single most important factor in emotional, mental and spiritual disharmony.
I have attempted to explain the essential link between this critical awareness and the integrity of Heart and Fire energies that make these herbs so important to our well being.
I have used the orifice opening and phlegm removing herbs together with the other classes of herbs listed above to treat the entire spectrum of psychological misery from the least to the most disturbed.
The subject is vast, addressed in other writings past, present and certainly future.
i Purdom, C.B. (1971). Meher Baba; The universal message. The God-Man, pp.343-344. Meher Spiritual Center, South Carolina.
ii Camus, A. (1989) The stranger. New York: Vintage Books
iii Jarrett, L.S. (Spring/Summer 2007)“The awakening of choice.” California Journal of Oriental Medicine, Vol. 18 No.1.
iv Fromm, E. Eulogy to Harry Stack Sullivan at Carnegie Hall in 1949
v Campbell, J. Unavailable at this time.
vi Hammer, L. (1992) The Chinese healing art/science and power. American Academy of Acupuncture Review; Vol 4, No. 1,
vii Osler, W. Unavailable at this time.
viii Hammer, L.. (2006) The therapeutic relationship [for Chinese medical practitioners]. DRCOM
ix Lingshu, The spiritual pivot. chapter 8
x Hammer, L. (2005) Dragon rises red birdfFlies; chapter 10.Seattle: Eastland Press.
xv Enzinger, I. Personal Communication. July 27, 2007.
xvi Hammer, L. (1966) Towards a Unified Theory of Chronic Disease. Oriental Medical Journal, Vol 6, No. 2 & 3.
xvii Fruehoff, H. Personal Communication. June 29, 2007.
Dr. Leon Hammer is a medical doctor, psychiatrist, and psychoanalyst who has studied, practiced, and taught Oriental medicine for 35 years. He is currently chairman of the Governing Board of Dragon Rises College of Oriental Medicine where he teaches and writes. He is the author of many articles to be found at: www.dragonrises.edu, and of Dragon Rises Red Bird Flies and Chinese Pulse Diagnosis: A Contemporary Approach (Eastland Press). For further information please contact www.leonhammer.com