KristinWisgirda: December 15, 2020, 6:13pm
The status of the thenar eminence can be so helpful when calling out Stomach and Lung excesses. When the
thenars aren’t flat as pancakes or plump and smooth like loaves of bread, it can be harder to call.
Stretching the thumb out and letting the thumb fold in toward the palm can change the appearance. Recently I
asked Toby for a reminder on tips for the thenars. He wrote back:
My teacher would palpate and evaluate the thenar eminence when it was in a relaxed neutral position.
George_Mandler: December 15, 2020, 8:59pm
For me this is another one of those signs that can have me go sideways in a diagnosis. For example right now I
have a 52yo woman on that table who clearly needs ST+ supplementation. Today is the third treatment – the first 2
ST+ supplementation treatments were in her words “a miracle”. (I was surprised too!) I just checked her thenar
eminence and they are like an empty sac both sides. Sometimes things don’t add up.
Daniel: December 16, 2020, 2:30am
yeah, when I see a patient with a vacuous thenar eminence, I always feel strongly influenced by that – especially
when they have been sick a lot or a very fatigued.
One thing I have noticed quite a bit and have been meaning to post here is that i often find the left thenar emimence
is more empty than the right thenar eminence . . . I wonder if that has to do with there being two lobes for the left
lung and three for the right lung?
KristinWisgirda: December 17, 2020, 1:27pm
Daniel:
i often find the left thenar emimence is more empty than the right thenar eminence . . . I wonder if that has to10/01/2024, 13:22Thenar evaluation – Qiological Community
https://forum.qiological.com/t/thenar-evaluation/1435/print2/3
do with there being two lobes for the left lung and three for the right lung?
Interesting observation. Other possible considerations are a prevalence of right handedness and from Su Wen 52
“the lung stores on the right.”
An accumulation of experiences leads me to giving thenar presentation more weight than morphology and skin for
Lung/St, especially when the thenar presentation is clear.
George_Mandler: December 17, 2020, 2:24pm
KristinWisgirda:
An accumulation of experiences leads me to giving thenar presentation more weight than morphology and skin
for Lung/St, especially when the thenar presentation is clear.
So if you had a slightly overweight person with dry skin adequate resources but deflated thenars you would
consider supplementing LU+. ?
I am going to pay closer attention. I have a patient where supplementing ST+ has worked extraordinary well but
her thenars are flat, I wish we were closer I’d send her to you for your eval.
Daniel: December 17, 2020, 2:40pm
Yeah, I find this a tough one and very much for me a ‘work in progress’ in terms of accumulated clinical wisdom. I
have had patients with NO OTHER signs of Lung Deficiency or Stomach Excess (except often fatigue is in the
picture) and their thenar eminence is EXTREMELY deflated. I find it very hard to ignore or downgrade that
finding – it always feels intuitively to me to be of high and weighty significance.
KristinWisgirda: December 17, 2020, 2:56pm
George_Mandler:
So if you had a slightly overweight person with dry skin adequate resources but deflated thenars you would
consider supplementing LU+. ?
Yes. If the thenars are clearly deflated, and it was relevant to the chief complaint, I would start with Lung+ and
then watch the patient very, very closely.
Similarly, if the thenars are very full but the patient is thinner with normal to moist skin, I would start with10/01/2024, 13:22Thenar evaluation – Qiological Community
https://forum.qiological.com/t/thenar-evaluation/1435/print3/3
Stomach+ if it was relevant to the chief complaint.
The thenar presentations I’m talking about are not middle of the road but clearly deflated or clearly overinflated.
Occasionally, I have had to toggle Lung and Stomach too. One patient with Lung excess morphology and deflated
thenars had miraculous results from St+ for her shoulder pain and Lung+ for the thumb pain that was aggravated
by the ST+ treatment. Her dad has the same Lung excess morphology and deflated thenars with very wet phlegmy
Lungs . ST+ was a bad choice for him and he responded well to Lung+. So much for wet lungs being internal
dampness.
This is the current state of my practice. Surely a patient will come along and take the wind out of this approach.
Daniel: December 18, 2020, 1:53am
one way to look at these things is through the lens of the ecology of pathological over compensation (I think
Jeffrey Yuen talks about this a lot) . . . so phlegmy lungs may be an over compensation for some kind of deeper
lying dry lung dynamic in which case moistening the Lungs through a Lu+ treatment may have relaxed an
underlying Lung Dryness physiology such that a more superficial level could stop producing so much phlegm to
try to compensate. The body (and the mind too – systems like the enneagram – are very much about
overcompensations) is always trying to course correct – but when things are really out of whack, the course
correction leads to many strange paradoxes that perhaps need to be understood and treated counter-intuitively. I
suspect the cases we find that need ‘toggling’ are very much in that kind of scenario
KristinWisgirda: December 18, 2020, 12:04pm
The case of the patient with wet lungs responding to Lung+ is a frail elderly man with mulitisystem qi and yang
deficiency. The likely pathomechanism of the wet lungs is that he doesn’t have enough yang to warm and move the
fluids. Lung/st aren’t just about damp and dry, they are about how the body takes in, stores and processes
resources/qi. While my patient is full of fluids, the flat the bars point to his qi xu. This goes back to my personal
take on evaluating Lung/St- are they under or over inflated?