The Tight Pulse (jin mai) and Hammer's Tight quality

I teach learners who are headed for examinations and practice in the field. Thus, I feel a responsibility to ensure that they are familiar with the term sets that they will encounter in peer review.

As a matter of my background relative to this conversation, I began studying Hammer's work in 1989. One of the reasons that I moved to the Berkshires in 1991 was to study with him. By 2001, Leon and I parted ways for issues surrounding nomenclature. I still made certain his work got published in the American Acupuncturist and also got him speaking engagements at the national conventions long after 2001. In 1996, I introduced Leon to David Bole, the person from whom he purchased Dragon Rises College of OM. Since those days in the early 1990s, I never stopped using or teaching Leon’s work.

While there has been some drift in what Hammer teachers, the system has not changed so remarkably. It is still recognizable as the body of work represented in Chinese Pulse Diagnosis: a Contemporary Approach. The book’s core content was constructed from handouts that we used in 1992.  

We still need pulse features that are more specific to the condition of cold than Chinese Pulse Diagnosis: a Contemporary Approach provides. This means that there is an image that is more specific to the physiological impact of cold on the system: that is the tight pulse (jin mai). This tight pulse (jin mai) of the conventional term set as Hammer has established, is not his Tight quality. While any given pulse may be found in the presence of cold, Leon's Thinner, Harder definition of Tight is more commonly present under the conditions that he describes in Chinese Pulse Diagnosis a Contemporary Approach, and as a general interpretation: heat from yin deficiency and some blood deficiency. Of course any given pulse may have various interpretations in differing contexts and this one is no different. So also, a particular condition may express with different pulses.

We look for trends in the sign symptom complex and there are assumptions about the pulse which allow us to focus the inquiry. The assumptions for Hammer’s Tight quality are distinctly different than those of the tight pulse (jin mai), partly because they are different events with different processes that contribute to the presentation. It is not a situation where anything goes, otherwise, rigor is lost. Some pulses have a wider array of possible interpretations than others. But, I am happy to see that the Shen-Hammer (S-H) school of thought is getting away from one-to-one correlations between pulse findings and interpretations which composed so much of the practice in the 90s. 

Practitioners feel what they feel and I trust that. I am in full agreement with multiple and often paradoxical findings in a single position. This is an important contribution from Shen and Hammer.  And, this is not my point. I can appreciate that we do not need one system of terms, and I have not suggested that there be such a mono set of terms. I do, however, think that we as a community involved in using a technical professional language have a responsibility to engage the larger field in a consensus process. This helps to prevent errors in translation and arbitrary contributions that lose sight of the existing term set.

It is entirely reasonable to define terms and declare what they signify. If it “leads from observation, to hypothesis, to synthesis with other diagnostic parameters, to diagnosis, to treatment principle to treatment, it works.” Diagnosis often occurs in a more chaotic and non-linear fashion. But, this is an accurate representation of the formal western approach to diagnosis. This linear approach to diagnosis is a valuable skill, and I use it. This is also not my point here.

What happens in the clan is one thing and what happens in the field at large is another, they are two separate logical domains. When I publish discussions related to the clan, or my experience, I feel a responsibility to make the distinction from the conventional lore. And that requires that I communicate the conventional body of knowledge in addition to what I know in clan-speak. While we agree with the doctrine of correspondences and find that mode of thought clinically useful, we can agree to disagree about clarity when using insider terms and conventional terms.

The risk of insider term sets is the promotion of separatism, them and us points of view, and a hierarchical position of dominance based upon a presumed superior knowledge base. This risk is present in all professional language systems. It is a form of social closure. That closure which conventional medicine used to keep this discipline out, or that we use to define licensure which keeps people from the profession who have not pursued a course of study is a form of vertical closure. The closure that happens in a discipline such as ours and with a specialty study such as Shen-Hammer pulse is a lateral form of closure. I am interested in de-mystifying and opening the borders. This is clearly an area where our interests part ways.

At the same time, we must recognize the very real contributions Leon has made with the cotton quality, the ropy quality, changing qualities and so forth. We are left with the responsibility of making our public communications clear when a term is used idiosyncratically within a sub-community of practitioners. That is what I am trying to accomplish here and as an example with the use of the term Tight quality vs. tight pulse (jin mai).  

I modify the discussion in Chinese Pulse Diagnosis: a Contemporary Approach to comport with the field in those areas where I see errors and in those areas where it is unnecessarily confusing.  I retain those features that are unique and clinically indispensable. I teach learners who are headed for examinations and practice in the field. Thus, I feel a responsibility to ensure that they are familiar with the term sets that they will encounter in peer review.

As a matter of my background relative to this conversation, I began studying Hammer's work in 1989. One of the reasons that I moved to the Berkshires in 1991 was to study with him. By 2001, Leon and I parted ways for issues surrounding nomenclature. I still made certain his work got published in the American Acupuncturist and also got him speaking engagements at the national conventions long after 2001. In 1996, I introduced Leon to David Bole, the person from whom he purchased Dragon Rises College of OM. Since those days in the early 1990s, I never stopped using or teaching Leon’s work.

While there has been some drift in what Hammer teachers, the system has not changed so remarkably. It is still recognizable as the body of work represented in Chinese Pulse Diagnosis: a Contemporary Approach. The book’s core content was constructed from handouts that we used in 1992.  

We still need pulse features that are more specific to the condition of cold than Chinese Pulse Diagnosis: a Contemporary Approach provides. This means that there is an image that is more specific to the physiological impact of cold on the system: that is the tight pulse (jin mai). This tight pulse (jin mai) of the conventional term set as Hammer has established, is not his Tight quality. While any given pulse may be found in the presence of cold, Leon's Thinner, Harder definition of Tight is more commonly present under the conditions that he describes in Chinese Pulse Diagnosis a Contemporary Approach, and as a general interpretation: heat from yin deficiency and some blood deficiency. Of course any given pulse may have various interpretations in differing contexts and this one is no different. So also, a particular condition may express with different pulses.

We look for trends in the sign symptom complex and there are assumptions about the pulse which allow us to focus the inquiry. The assumptions for Hammer’s Tight quality are distinctly different than those of the tight pulse (jin mai), partly because they are different events with different processes that contribute to the presentation. It is not a situation where anything goes, otherwise, rigor is lost. Some pulses have a wider array of possible interpretations than others. But, I am happy to see that the Shen-Hammer (S-H) school of thought is getting away from one-to-one correlations between pulse findings and interpretations which composed so much of the practice in the 90s. 

Practitioners feel what they feel and I trust that. I am in full agreement with multiple and often paradoxical findings in a single position. This is an important contribution from Shen and Hammer.  And, this is not my point. I can appreciate that we do not need one system of terms, and I have not suggested that there be such a mono set of terms. I do, however, think that we as a community involved in using a technical professional language have a responsibility to engage the larger field in a consensus process. This helps to prevent errors in translation and arbitrary contributions that lose sight of the existing term set.

It is entirely reasonable to define terms and declare what they signify. If it “leads from observation, to hypothesis, to synthesis with other diagnostic parameters, to diagnosis, to treatment principle to treatment, it works.” Diagnosis often occurs in a more chaotic and non-linear fashion. But, this is an accurate representation of the formal western approach to diagnosis. This linear approach to diagnosis is a valuable skill, and I use it. This is also not my point here.

What happens in the clan is one thing and what happens in the field at large is another, they are two separate logical domains. When I publish discussions related to the clan, or my experience, I feel a responsibility to make the distinction from the conventional lore. And that requires that I communicate the conventional body of knowledge in addition to what I know in clan-speak. While we agree with the doctrine of correspondences and find that mode of thought clinically useful, we can agree to disagree about clarity when using insider terms and conventional terms.

The risk of insider term sets is the promotion of separatism, them and us points of view, and a hierarchical position of dominance based upon a presumed superior knowledge base. This risk is present in all professional language systems. It is a form of social closure. That closure which conventional medicine used to keep this discipline out, or that we use to define licensure which keeps people from the profession who have not pursued a course of study is a form of vertical closure. The closure that happens in a discipline such as ours and with a specialty study such as Shen-Hammer pulse is a lateral form of closure. I am interested in de-mystifying and opening the borders. This is clearly an area where our interests part ways.

At the same time, we must recognize the very real contributions Leon has made with the cotton quality, the ropy quality, changing qualities and so forth. We are left with the responsibility of making our public communications clear when a term is used idiosyncratically within a sub-community of practitioners. That is what I am trying to accomplish here and as an example with the use of the term Tight quality vs. tight pulse (jin mai).  

I modify the discussion in Chinese Pulse Diagnosis: a Contemporary Approach to comport with the field in those areas where I see errors and in those areas where it is unnecessarily confusing.  I retain those features that are unique and clinically indispensable. 

Unraveling the Mysteries of Nan Jing Chapter Five Pulse Diagnosis:

© 2004 William R. Morris, L.Ac., OMD, MSEd,

The classics can be obscure, appearing to have little clinical relevance. However, useful interventions can be discovered through study and contemplation. The question is not whether the resulting application is what the ancients intended. The question is whether the resulting clinical application is useful and can make a contribution to the field.

This paper discusses some practical applications of Nan Jing Chapter Five as found in Tu Ju Wang Shuhe Mai Jue Ba Shi Yi Nan Jing Bien Zhen (Pictorial Notes on the Pulse Songs of Wang Shuhe).¹ The five depth system is also discussed in other important texts of Chinese Traditional Medicine including the Mai Jing (Pulse Classic)² and Li Zhi Shen’s Pulse Diagnosis.³ While each text discusses the method of pressure to assess the five depths, none of these sources discuss the practical application of the method.  The Nei Jing and Nan Jing both describe three dimensional models for pulse diagnosis. Each position represents a burner as does each depth. The trick is making sense of this set of possibilities, and the solution is to focus on each aspect, one at a time. For instance if the distal positions are weak, this suggests depletion in the upper burner (the nature of the depletion will depend on other signs and symptoms.)

Methodology

In Chapter Five, beans are used to signify the depth of pressure. “With a very light hand press superficially and then press harder; 1^st depth is 3 beans pressure to the lungs and skin, 2^nd depth is 6 beans to the heart and the vessels, 3^rd depth is nine beans to the spleen and flesh, 4^th depth is 12 beans to the liver and sinews, 5^th depth is 15 beans to touch the kidney and bones.⁴” Please note:  depth is based on light pressure at the skin and deep pressure close to the bone rather than using the vessel as the starting and ending point.  For instance, the fingers are not merely pressing at 6 beans of pressure to examine the heart, one is pressing with an intention to examine the vessels.

The table in Pictorial Notes on the Pulse Songs of Wang Shuhe from the Qing Dynasty includes only the organ, weight, and tissue level. This table adds other correspondences such as the phase and the corresponding perception.  

Phase	Organ	Beans weight in pressure	Tissue control by organ	Sense
Metal	Lung	3	Skin	Smell
Fire	Heart	6	Vessels	Speech
Earth	Spleen	9	Muscle	Taste
Wood	Liver	12	Tendon	Sight
Water	Kidney	15	Bone	Hearing

Table 1 Systematic Correspondences

This method can be reduced and made simple. Divide the region between the skin and the bone into three areas this is the heaven human earth method. Then, in the qi depth (heaven) is divided into metal and fire while the organ depth is divided in to wood and water.

3 beans pressure	Heaven or qi depth	Upper burner	Skin
6 beans pressure			Vessels
9 beans pressure	Human or qi depth	Middle burner	Flesh
12 beans pressure	Earth or organ depth	Lower Burner	Sinews
To the bone and lift			Bone

                                    Table 2 Three depths and five depths correspondences

Application

The ability of an organ to control the tissues is another indirect suggestion that occurs in Nan Jing Chapter Five. For instance, the spleen's capacity to control the flesh is evaluated at the middle depth. To examine the biceps, explore the middle depth in the right distal position this provides information about the muscles and flesh along the trajectory of the lung vessel. Or, use the middle depth (earth and spleen sector) in the proximal position to examine the musculature of the lower back.

There may be either excess or deficient signs at any depth. Even technique on the corresponding transport point will generally cause the anomaly to self correct.

The operating premise is predicated upon fractal and holographic thinking. That is a correction in a part will reflect corrections in the whole.

Applications of the five depth model

1. diagnosis
2. point selection
3. needle depth and breadth placement within a point

Diagnosis – a pulse with the metal and fire areas absent (qi depth) suggests a qi depletion pattern. It can also suggest that the capacity of the upper burner is diminished. The treatment is to select points, herbs and qi gong to increase qi in the upper burner. Acupuncture could include tonification of back-shu or front-mu points, medicinals that supplement the qi of the heart and lungs are another possibility. Qi gong methods include those that stretch the heart and lung vessels such as expanding the arms laterally so the angle of stretch is along the vessel. Cardiovascular exercise maybe recommended if appropriate.

Point selection – the depth where a depleted sensation or replete sensation is identified suggests a corresponding transport point on a channel. For instance the left middle position corresponds to the liver orb of influence. If the pulse is floating and there is no root, needling the water point on the liver channel usually cause the root at the liver position to fill in.

The standard needle depth can be divided into five and the region corresponding to the tissue layer is needled. The pulse can be palpated while the needle depth is adjusted to refine the depth of insertion. The distance within the point range can be divided in to five sectors, the area closest to the bony land mark is the water area – look for the most tender spot or palpate for the spot that correct the pulse depth. `   

Case Example:

Case: 54 year old female undergoing chemotherapy for breast cancer, her pulse is thin and weak (it was also absent at the water depth in the left middle  position) , the tongue is pink and thin – this is due to a qi and yin depletion pattern. She has fatigue, leukopenia, no appetite, nausea. In addition, when she received typical TCM style point selections such as Sp10, St 36, Sp6, Lu 9, K6 for a standard amount of time, she would experience a collapse of energy and remain in bed the whole next day. Whereas when the strategy of supplementing the liver water point, and supporting that treatment through the biao-li interior exterior channel method including Lr 8, GB44 and SJ 5…this was combined with corresponding mu points Ren 5, Lr 14, GB 24. She felt relief, increased energy, and diminished nausea. In addition, her leukopenia went from a count of 2,600 to 3,800 cells/µL/cu mm over the period of one week with two treatments based on balancing the five depths of the liver position.

1. Qing Y. Tu Ju Wang Shuhe Mai Jue Ba Shi Yi Nan Jing Bien Zhen (Pictorial Notes on the Pulse Songs of Wang Shuhe): Yi An Tong, Shu Lin, Qing Dynasty.

2. Wang S. The Pulse Classic A Translation of the Mai Jing: Blue Poppy Press, 1997.

3. Zhen LS. Pulse Diagnosis. Brookline, MA: Paradigm Press, 1981.

4. He WS. Wang Shu Tu Zhu Nan Jing Mai Jue

(Wang Shu He Picture Chart Markings of the Nan Jing and Mai Jue): Jin Lun Tang, Qing Dynasty.