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1. What might it mean when there are findings on both sides for the
diaphragm pulse, but the quality differs from side to side? Eg, one side
is stronger than the other? Or one side feels inflated and the other
slightly wiry? Hammer mentions L and R diaphragm positions on p. 74 and
80, but I don't know about comparing the two sides.
It must be a positive diaphragm quality on both sides to indicate 'repression of tender feelings.' That is - it is inflated (tense and full) between the middle and distal positions. If it is a different quality on each side, it can be related to the anatomical structures that come to bear on the diaphragm from above, below, left or right. Lastly, based on my own work... between the diaphragm and the organs of the upper burner is the mo yuan. There can be uneven accumulation of materials that is unevenly distributed. It is up to you to do the detective work that will explain why this sensation is present in a given individual.
2. How might I interpret a change in the pulse during an intake?
Specifically, in one patient the distal position initially seemed stronger
on the R than the L, but at a later moment, the L pulse became stronger &
fuller than it had been and perhaps even stronger and fuller than the R.
Hammer mentions "changes in intensity undulating from one wrist to
another" on p. 138, and says that it's associated with "a current and
powerful interpersonal conflict." Is the pulse he describes one that
shifts back & forth from side to side repeatedly? I may have been feeling
changes in amplitude on the L, rather than changes in intensity from side
to side.
Changes in amplitude that occur on left are related to weaknesses of the organ level qi, in other words a rather deep depletion of qi. If it is in one position, it is the qi depletion of that particular organ.
In another patient, his middle R position initially felt wiry & strong
superficially and yielding, but later softened to feel wide and flat at
the mid level. That is, there was initially an abrupt edge to his pulse,
but then the crest of the wave seemed to flatten out. Does Hammer talk
about changes in the pulse for this position? I saw that he has something
on the L middle position.
Under these circumstances, the physiology of the pulse cannot be expressed all at once. Each process that is occurring in an area then occurs in sequence as the changing qualities you have detailed. Qi stagnation due to excess, as well as qi stagnation due to deficiency must be considered in this case.
3. I felt a pulse where the initial impression was that the vessel felt a
little deep or distant from the skin, as in the case of "cotton." But the
patient's physique is average or slightly slender. Is it simply that the
patient's skin is a little tough and thick? I wonder if it might be a
"leather" pulse (p. 255), but Hammer says these are rare, and the patient
didn't seem to be have such a severe condition! Any other reading of this?
The leather pulse describes a thickening of the arterial wall such that you are pressing through thickened material. It could be that the pulse is deep in this position that would give the sensation you are describing.
4. If the pulse on one side (L) is all around deep & weak & even difficult
to palpate, how might I interpret this? The pulses on the R were not weak,
rather generally wiry & strong. The patient had no injury to his L
shoulder nor arm.
This is suggestive of constitutional weakness - that is 'poor protoplasm poorly put together P-P-P-P-T.' I would inquire for any family history of the chief complaint.
5. I felt a couple of unusually shaped vessels. One patient's L middle
position felt like a wiry vessel protrusion, the vessel came up like a
wiry bump just at this one position. Interpretation?
This is fairly common in the left middle position. If it is elevated, short and vibrating - it can be the 'spinning bean.' However, this pulse usually occurs in the presence of a severe emotional state or some chemical problem such as a drug reaction. It usually goes away quickly and easily through needling UB 18-19 , the back shus that correspond to the left middle position.
Another patient had a L vessel that could be scooted (not just rolled)
from side to side, particularly near the 1st position. Might this indicate
anything in particular?
If the vessel is that discrete from the surrounding connective tissue, I would consider a 'ropy' pulse as a possibility.
Best - Will
Will Morris, L.Ac., OMD, MSEd
Dean of Educational Advancement
Emperor's College
Secretary AAOM
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