Phlegm Misting-Disturbing the

Orifices and Mitral Valve Prolapse

Leon Hammer

Introduction I encountered an oft-repeated explanation, that ‘Phlegm-

My initial appreciation of the role of the heart, in this instance the Fire congestion is the result of stagnant dampness from poor
valves of the heart, in mental-emotional illness occurred in medical digestion… that accumulates into mucus, combined with
school, since in biomedicine at that time the prolapse of the mitral excessive heat from Liver qi stagnation. Since food is eighty per
valve was associated with panic attacks and phobias. Therefore it cent water, a weak Spleen (and/or Triple Burner), or excessive
was a simple cognitive step from that information to identifying fluids or food that is difficult to digest can leave the digestive
other aspects of Heart function, the orifices in Chinese medicine, tract with more dampness (water) than it can handle. Chinese
with psychological conditions. My work with my teacher, Dr John medicine teaches that this dampness (water) normally ascends
H.F. Shen, and his emphasis on the relationship of the heart valves to the Lung with Spleen energy to be “digested” or, more
and vessels to mental-emotional issues reinforced that initial accurately, “misted”. If, in addition to poor digestion, the Lungs
connection with the concept and clinical reality of ‘Phlegm misting are weak and cannot “mist” this dampness that is normally
the orifices’. dispersed through sweat or moved downward to the Kidneys, the
dampness accumulates into mucus. Longstanding Heat from Liver
Concepts qi stagnation transforms into Fire and combines with the mucus
When encountering a slippery quality at the mitral valve position to become the more viscous substance referred to as Phlegm-Fire,
according to the Shen-Hammer pulse system we discovered that which goes to the Heart where it disturbs the orifices’ [iii].
in all instances allopathic medicine had identified a ‘mitral valve
prolapse’. All of these patients presented with moderate to severe My clinical experience pointed elsewhere. Shock to the Heart
emotional problems. Furthermore and as important, when I is initiated by any sudden event that the Heart experiences
employed the aromatic herbs described in my paper ‘Awareness’ or anticipates as a danger to its existence, physical, mental,
[i] I found remarkable resolutions of the symptoms ascribed to emotional and spiritual. These are personal, usually unexpected
‘Phlegm misting the orifices’ in Chinese medicine, as well as the hurtful emotional experiences that cause the feeling associated
panic and phobias associated with `mitral valve prolapse’. with the Heart to withdraw, mostly for purposes of protection
from further hurt. Sudden severe physical trauma can cause a
It is important to me that I understand the pathophysiology of fright that will lead to similar stagnation.
Chinese medical conditions within the language and concepts of
this medicine. What are the `orifices’; what is Phlegm and how With shock the ‘qi’ of the Heart retreats or closes off outside
does it appear in the Heart? Why would mitral valve prolapse be contact to various degrees and this may ultimately include Blood
associated with panic and phobias? as well as fluid. [See the discussion below]. This retreat may be
conceived as being a protective function of the Pericardium.
Standard answers to the question, ‘What are the orifices’ were Dr Shen referred to these conditions as ‘Heart closed’ [qi
invariably that they are the seven or nine orifices to the outside, stagnation (Flat or Inflated pulse quality)] or ‘Heart small’
especially the upper seven. The explanation of Phlegm was the [Blood stagnation – (Choppy pulse quality)]. A third pulse
blocking of the orifices by disquiet in the Heart due to impure quality indicating qi stagnation, Muffled, is associated with a
thoughts, feelings and cravings. This is well expounded by dysphoric depression and possibly also involved in the formation
Stephen Higgins in his thesis on the orifices [ii]. While I could of phlegm [iv]. Note: While on the pulse, the lower burner
appreciate the truth herein I was not satisfied with the lack of informs us of a person’s foundation, the middle of their stability,
a mechanism that I could use to understand the process and the upper burner tells us how well they can reach out to the
therefore evolve a clinical approach. Yes, the aromatic herbs could world. The palm of the hand that reaches out contains Heart
dispel the Phlegm, but how was the Phlegm created and how did and Pericardium points and in addition the finger tips the Small
it get to the Heart? Intestine and Triple Burner points.

34 The European Journal of Oriental Medicine

 Phlegm Misting-Disturbing the Orifices and Mitral Valve Prolapse

Leon Hammer

‘ Since in Chinese medicine

Since in Chinese medicine the movement of qi is necessary for
life, the organism experiences stagnation as dangerous and
automatically acts to overcome it. The physiological mechanism
begins by bringing metabolic [normal] heat to overcome the the movement of qi is
stagnation; if it succeeds, then there is no problem; if the
stagnation is greater then the ability of the metabolic heat to
necessary for life, the
move it, the metabolic heat starts accumulating and becomes
`excess Heat’.
organism experiences
stagnation as dangerous
The body experiences ‘excess Heat’ as a toxic pathogen and
attempts to eliminate it, or failing that, balance it with something and automatically acts to
overcome it ’
cool that we call yin or fluid. This combination of accumulating
Heat and fluid consolidates as Phlegm that ‘mists’, ‘confuses’ or
‘obstructs’ the Heart orifices [v]. This mechanism is increasingly
more common today than the scenario involving the Spleen and
Liver mentioned above [vi].

I reiterate that in our time ‘Heart shock’ is the primary aetiology of her to see me, she wouldn’t or couldn’t stand still; she kept
the condition ‘Phlegm misting-disturbing-confusing the orifices’. running around this large room, going in a sort of circular
What are other minor sources of stagnation leading to this counter-clockwise motion around and around.
disorder? Clinically I have observed arrhythmias, especially atrial
fibrillation, obstruction from the Lung, Heart qi deficiency in which She wouldn’t stand still long enough for me to talk to her or
the qi is too deficient to move qi and a Heart type of depression to take her pulse – she just kept running. Then, she suddenly
associated with the Muffled quality in the left distal position that I tripped and fell and I managed to grab her hand and felt her
call ‘Dysphoric’ [vii] and Heart Fire Bipolar mania-depression [viii]. left distal position, and it was very slippery. I had nothing else
to go on except that I’d felt her left distal pulse and felt this
Clinical Experience slippery quality when she’d fallen down.
Generally speaking, patients with a slippery quality in the left
distal position, or both distal positions, slippery in the ‘mitral valve With the assumption that this was `Phlegm misting-disturbing
position’ or even some kind of relatively significant emotional the orifices’, I started treating her with Niu Huang Ching Xin
problem, I would usually begin with herbs that removed Damp Wan, a very powerfully acting formula particularly effective
from the Heart, chang pu, huang qi, as part of a formula that for a psychotic condition. Within three days she ceased to run
simultaneously addressed other Heart conditions [blood, qi and around the room, to try to kill her husband [no one knew why
yin deficiency, etc. See Appendix I. including her daughter] and behaved normally.

The most effective formula in acute conditions was Niu Huang She continued to take the Niu Huang Ching Xin Wan for
Ching Xin Wan, continuing with something milder if they three months and was completely sane until her ‘born again
responded favorably. With this approach I had considerable sister’ from somewhere in the south came to live with her,
success with neurosis and personality disorders and with psychosis hearing that she was taking ‘medicine’. The sister, the family
when the rare opportunity occurred. matriarch, was from some extremist sect that didn’t believe in
any form of medicine, and so she convinced her sister to stop
Case One taking the Niu Huang Ching Xin Wan.
The most dramatic patient that I recall was a woman about 60 or
so, who was referred to me in 1985 by her daughter, a nurse. She I don’t know exactly how long it took for her to revert to her
was a diagnosed schizophrenic, and when her daughter brought psychotic condition because her sister wouldn’t let her see

The European Journal of Oriental Medicine 35

me. Not too long after that, her husband was taking a trip by Discussion
air and was waiting in the airport when she appeared With regard to the aetiology of the disorders presented by these
and tried, unsuccessfully, to kill him. That’s the last I heard children, Dr Shen would say “How can be, brand new” pointing
about her. to some form of in-utero Heart shock. Kidney Essence is the force
that guides foetal development and is also compromised.
Case Two
There was one other dramatic experience that involved a year- Since I did not have the opportunity to employ my usual
and-a-half-old child. The mother was referred to me, and she diagnostic tools except for his tongue [mucus], the assumption
came in with three children, the other two being one aged that these children’s Chinese medical condition is ‘Phlegm misting
three and one aged five. the orifices’ is based only on the extraordinary positive response
to a Chinese herbal formula that is indicated in the literature for
The patient was a one-and-a-half-year-old boy who she had a wide range of ‘Wind’ neurological disorders mostly involving
to hold at arm’s length because he was constantly trying to hit the restoration of consciousness associated with extreme Heat
her. She said that this went on day and night since he and Phlegm. The formula is also said to clear Heart Heat and
had been capable of assaulting her. She had been seeing pacify the Spirit. [Note: The pulse is not reliable in children and
a Five Element acupuncturist who I knew, who had referred tends to change from day to day along with their ever changing
her to me. maturation].

I saw his tongue and it had a lot of mucus on it. On the The lingering question is how did this Heat appear sufficiently
assumption that he had ‘Phlegm misting the orifices’, I during the nine months of two pregnancies four years apart to
suggested that she try very tiny amounts of Niu Huang Ching produce Phlegm that could ‘disturb’ the Heart? I saw this woman
Xin Wan. It came in balls: a sort of soft gumming substance as an urgent referral by another acupuncturist at a time when I
that you could cut up. She went home and came back a couple was not in a regular practice, just teaching and writing. I did not
of days later and the little boy was not trying to hit her. She get a sufficient history of her pregnancies to know if she had had
was carrying him, and he looked perfectly normal. toxaemia of pregnancy or some fever producing illness that could
have affected two foetuses in two separate pregnancies four
She said that she’d tried to cut up the Niu Huang Ching Xin years apart.
Wan in very small amounts and to get him to swallow it, but
he wouldn’t swallow it. This woman was very creative, she Since then this technique has proven to be very valuable with
dissolved a small amount of the Niu Huang Ching Xin Wan in other children with ADHD [formerly called Minimal Brain Damage].
water and then used an eyedropper and gave it to the little boy
rectally. It worked. I followed them for five years and he had Conversation
reverted to being a perfectly normal little boy. She’d only given ‘Phlegm misting the orifices’ is a general term that from the
him Niu Huang Ching Xin Wan for a couple of months at literature includes:
the most.
1. ‘Phlegm-Fire disturbs the Heart orifice’ marked by irritability
She also had a five-year-old that was not physically violent and being easily startled and is an Excess Heat Heart condition.
but was very, very angry, and very unhappy. She started giving The allopathic diagnosis most closely approximating ‘Phlegm
him the Niu Huang Ching Xin Wan by mouth and he reverted Fire’ is the manic phase of bipolar disease, though excited
to being a relatively normal child. [This woman was pregnant phases of schizophrenia are mentioned along with epilepsy.
again when she came and had a three-and-a-half-year-old
daughter who was no problem. She and her husband were 2. ‘Phlegm confuses the Heart orifice’ marked by a lack of
evangelical Christians and planned to have as many children excitement, or depression and mental confusion. The
as possible. Subsequent to our initial contact her husband allopathic equivalent would probably be endogenous [inherited
developed pancreatic cancer and died within two years.] tendency] depression and the catatonic form of schizophrenia.

36 The European Journal of Oriental Medicine

 Phlegm Misting-Disturbing the Orifices and Mitral Valve Prolapse

Leon Hammer

3. ‘Phlegm obstructs the Heart orifice’ associated with stroke. This withdrawal in Chinese medical terms is initially qi stagnation
[`Heart closed’] that Dr Shen associated with a tendency to
It is my impression that patient number one was misdiagnosed jealousy and envy. A more advanced stage of the withdrawal
as schizophrenic. I discovered while living in England in 1971 mechanism is Blood stagnation [`Heart small’], the manifestation
that those patients diagnosed as schizophrenic were considered of which is profound fear. The associated pulse qualities
there to be bipolar of the `Phlegm-Fire disturbs the Heart orifice’ are discussed above. The nature of the mental-emotional
type. That view has been gradually adopted here in the USA. consequence in biomedical terms is in a continuum from mild
A separate issue not relevant for discussion here is the entire neurosis, personality disorders to the various psychoses.
allopathic diagnostic schema of mental illness. The differentiation of these disorders in terms of the degree
of ‘Phlegm misting the orifices’ is yet to be investigated.
I have identified shock to the Heart as being a primary source
of the stagnation that leads to the ‘Phlegm misting the orifices’ The result of this stagnation described above leads to the
condition. Dr Shen described the Heart’s response to shock to appearance of Phlegm in the Heart and to the subsequent
the Heart as draining yin. I explain this as the heart sending condition, the subject of this article, `Phlegm misting
blood [yin] from the periphery and itself to the internal organs to the orifices’.
protect them from whatever the danger to the organism.
Conclusion
Sheng Mai San is the formula of choice for treating shock ‘Phlegm misting [disturbs-confuses-obstructs] the orifices’ is
[along with Yunnan Pai Yao]. Sheng Mai San is composed of discussed above with regard to its aetiology, physio-pathology,
American Ginseng, which protects yin. Ophiopogon nourishes pathogenesis and clinical consequences, alluding to clinical
yin and schizandra astringes and thereby conserves it. Yunnan tools for diagnosis and treatment, and leaving us with profound
Bi Yo overcomes the stagnation of Blood that occurs with this unanswered questions with regard to all the above.
withdrawal while mysteriously initiating a clotting mechanism
that conserves it. We are left with useful instruments for intervention and a
plethora of the unexplained that challenge us all for time to
However, approximately simultaneously we observe the come. Or perhaps we should follow the advice of Lao Ze:
mechanism described above in which the Heart [Pericardium] ‘Hence always rid yourself of desires in order to observe its secrets
withdraws its qi from the outside world to varying degrees But always allow yourself to observe its manifestations’ [ix]
depending on its sense of its own vulnerability. and leave the inexplicable to higher powers.

Appendix I: the Mitral Valve Prolapse

The `mitral valve syndrome’ is, or was, associated in allopathic of the slippery quality in this position. For several years we referred
medicine with panic and phobia about which I learned in medical patients with this finding to cardiologists who confirmed the
college. As stated above, a mitral valve position is accessible presence of a mitral valve prolapse each time. The slippery quality
in the Shen-Hammer [CCPD] pulse system. Various qualities may has been associated with turbulence in another position and we
appear that indicate an incompetent mitral valve, a sign within assume that its presence in the mitral valve position indicates
this system of Heart qi deficiency. The `prolapse’ and concomitant greater incompetence of the valve that impairs Heart `shen’ in
panic attacks and phobias are associated only with the presence specific but unknown ways [x].

The European Journal of Oriental Medicine 37

Appendix II: Generic Heart Formula Build Heart Yang
A general formula for the Heart that I have recently developed is
Aconite fu zi 0.25gm
as follows. Additions and subtractions can occur depending on
the diagnosis, including Opening Heart orifice herbs and removing
Phlegm-Fire. The following is suggestive, not all-inclusive. [xi]. Move Heart Blood

Cinnamomum rou gui 3 gm

Heart Shock and Heart Yin Deficiency [Sheng Mai San]
Salvia dan shen 6 gm
American Ginseng xi yang ren 9 gm
Tu. Curcumae yu jin 6 gm
Ophiopogon mai men dong 9 gm
Ligisticum W. chuan xiong 9 gm
Schizandra wu wei zi 6 gm
[circulation to the brain]

Calm Heart and Nourish Shen [Blood and Qi]

Move Constrained Liver Qi and Liver Wind
Zizyphus suan zhao ren 9 gm
Cyperi xiang fu 6 gm
Biotae Seed bai zi ren 3 gm
Fr. Aurantii zhi ke 2 gm
Polygoni Multiflori ye jiao teng 6 gm
Uncaria gou teng 4 gm
Longan long yan rou 6 gm
Co. Halliotidis shi jue ming 3 gm
Albezziae he huan pi 9 gm
Gastrodia tian ma 6 gm
Poria Cocos fu shen 10 gm
Bupleurum chai hu 3 gm
Craetegus shan zha 6 gm
[very cold and drying especially in women]
Placenta zi he che 4.5 gm

Dragon Bone long gu 9 gm

Open Orifices and Remove Phlegm
Oyster Shell mu li 12gm
Acorus shi chang pu 6 gm
Dragon Teeth long chi 9 gm
Calculus Bovis niu huang 0.1gm
Succinum (Amber) hu po 1 gm
Polygala Tenufoliae ho shou wu 9 gm
Margarita zhen zhu 1-3 Fen
Poria cocus fu shen 9 gm
Licorice gan cao 5 gm

Wheat fu xiao mai 20-50 gm

Remove Excess Heat
Jujube da zao 5-20 gm
Scute huang qin 6 gm

Coptis huang lian 1.5 gm

Build Heart Qi

Ginseng ren shen 9 gm

Korean Ginseng 4.5 mg

Rx. Codonopsis dang shen 15 gm

38 The European Journal of Oriental Medicine

 Phlegm Misting-Disturbing the Orifices and Mitral Valve Prolapse

Leon Hammer

Appendix III: Literature

I. Refer primarily to Stephen Higgins discussion of the ‘Conduits Thus, the orifices of the heart are essentially the portals into and
of Consciousness: the Orifices of the Heart in Chinese Medicine’ out of this ‘seat of thought and emotions’, and they allow for
in the references page 37. communication between our inner experience and the outer
world. In short, these orifices are conduits of consciousness
II. Dr Ning Yu that, when unobstructed, grant the heart a capacity to observe
In ancient Chinese culture, the heart – not the brain – is the world clearly; and, in fact, according to Dr Yu, in modern
regarded as the centre of human consciousness, and the orifices Chinese the term ‘heart orifices’ (心竅) can even be translated
of the heart are portals into and out of this centre. According as ‘the capacity for clear thinking’. Because the orifices act
to cognitive linguist and Chinese language scholar Dr Ning Yu, both as conduits for sensory input into the body (or mind)
‘In Chinese, the word xin that primarily denotes the heart organ and the ‘radiance of [our] spirits’ (Larre), shen ming (神明),
may also refer to it as the “organ for thinking” and the “seat outward from the heart (or mind), it is these ‘free and open’
of thought and emotions” … in this way, the Chinese word xin (通) spaces that allow for a human being’s ability to understand
“heart”[心] covers the meanings of both “heart” and “mind” messages from the outside world and respond with ‘clear
as understood in English.’ It is our finding that in Chinese intelligence’ (Clavey). The various pathologies that can lead to
medicine consciousness resides inside of the metaphorical empty the obstruction of the orifices all affect this ability to clearly
space within the container that is the heart, and awareness is understand and respond to the world.
the product of that consciousness reaching out to and bringing
intelligible information back from the external world to the
heart via the orifices.

References

1 Hammer, Leon, I. (2007). Awareness in Chinese Medicine, 6 Hammer, Leon, I. (2009). The Liver in Chinese Medicine; Medical
The American Acupuncturist, Volume 41. Acupuncture, Vol. 21, No. 3: 173-178

2 Higgins, S. Conduits of Consciousness: the Orifices of the Heart in 7 Hammer, Leon, I. (1990, 2005). Dragon Rises Red Bird Flies;
Chinese Medicine; A thesis submitted to the faculty of the National Eastland Press; pp 291.
College of Natural Medicine; DragonRisesSeminars.Org
8 Hammer, Leon, I. (1990, 2005). Dragon Rises Red Bird Flies;
3 Hammer, Leon, I. (2001-5). Chinese Pulse Diagnosis: A Contemporary Eastland Press;: pp 291-2
Approach; Eastland Press; pp 570-1.
9 Dao De Ching
4 Hammer, Leon, I. (2012). Handbook of Contemporary Chinese Pulse
Diagnosis; Eastland Press; pp 189-190; 378, 381. 10 Hammer, Leon, I. (2007). Awareness in Chinese Medicine,
The American Acupuncturist, Volume 41.
5 Hammer, Leon, I. (2001-5). Chinese Pulse Diagnosis: A Contemporary
ejom
Approach; Eastland Press; pp 123.

The European Journal of Oriental Medicine 39