Chinese Medicine notes 04-04
From DmesWiki
TCM04-04 Oct 2. 2005
Palpation is usually referring to pulses, but that's difficult to learn. In general, we can palpate other things as well. We use the information that we've gathered from the other assessments and check with the body to get data based on what we have observed so far. We need to keep an open mind to verifying, not just proving what we already concluded.
We palpate the surface of the body for six factors: ( Heat--relative to normal for them ( Cold--relative to their normal ( Moistness ( Distention--swelling or fullness, puffiness. This can also be in a joint. ( Pain--in the sense that when you push they react ( Reaction to pressure--other reactions than ouch. Look at the face. Deficiency is if it feels good to have pressure. How they react to pressure is more than thinking about pain alone.
Five parts that you're going to palpate for the six factors: ( Skin ( Limbs ( Chest ( Abdomen ( Acupuncture points
When we palpate, we keep an open non-judgmental mindset, the same attitude as when you do your history taking.
Touch gently but firmly as needed, and with warm hands. Warm your hands before you touch them.
Keep them modestly covered apart from the part you are treating. If you go to their abdomen reveal that part alone. Keep in mind how would you like to be treated on that table and you can't go wrong.
When assessing for warmth and coolness use the palm. You are comparing the sense of that. You will feel that chi. It is a sensation in your hand. You can get the moisture at the same time you can get a sense of tenderness.
You can use your whole hand to assess swelling. If you find a place that seems swollen, push on it with one finger and see if the indent stays. That indicates a true damp accumulation. Non-pitting swelling or distention might be stuck chi. Swelling is different from a lump or mass.
Tenderness in specific points. Save this for last and go with your fingertips to the area of complaint.
Rules of thumb--a lack of warmth is a yang deficiency. Heat only in the soles or palms is cause by relative yang, a symptom of deficient yin.
The abdomen: For reflex purposes use the front mu points. They don't correspond to the location of the organ. They correspond to organ function. Kidney and liver mu points are near the intestines, for example.
There's a sequence to palpation, thinking meridian and organ at the same time.
Pain that's relieved with pressure is a deficiency. Acute pain usually means an excess or new pain. Deficiency is usually chronic. Hot is excess, especially if red. If it is cold, it will be a cold condition, etc.
A firm lump is a stagnation--an excess of chi that's formed in a lump. If you leave it, it will become a material mass, so it's bettter to disperse. A soft mass is a newer chi stagnation. The firmer the mass, the longer the stagnation. If you feel a rock hard mass like glass, get help from a doctor.
As we're palpating, we have the anatomy in mind in Western med. In TCM we're thinking about the meridian involved. Just palpate along the pain, and try to figure out which meridian it is. If it's more than one, you have to figure out which is worst. Or you might have one with excess and one with deficiency. You can get specific information from points away from the organ - certain points are diagnostic. For example, nausea, fatigue, low grade fever are pointing to hepatitis. You find liver 14 and bladder 19. You can tell that they have hepatitis.
Japanese acupuncture takes palpation to a science. In TCM they don't do so much palpation. You need to develop intelligence in your hands like the Japanese system. Abdominal palpation (hara) is another way to distinguish energetic imbalances.
The hara is particularly important for several reasons, in Japanese and in TCM. The location is variable--techniically it's the moving chi between the kidneys. You can feel it on yourself and find out where yours is. its function is deeper than the organs, how the organs can work. The center is like our vital center, our center of gravity, where our gut reaction comes from. In the Yellow Emperor's book, it says that someone with perfectly normal pulses can die. But each of the 12 meridians has a relationship to the hara (source of chi). That source is fundamental to the 10 organs, the root of the triple warmer, the root of the 12 meridians, and the gate of the breathing.
Another name for it is the shen which protects against evil. If the root is dying the stems and branches can be drying up and yet appear normal. It is the energetic center from which life springs. The very core of the fetus develops around this energy. If we can treat the hara, we can prevent illnesses that the person doesn't even know are coming yet.
All the meridians have an internal flow and it protects the hara. If you were to lay the meridians on top of one another you would see that they all come to the abdomen. By listening to the subtle energies of the hara you can tap into energy deeper than you could otherwise. Their body might not let you go to the depth they want to go as well.
The abdomen may tell you to do another treatment and then you get that to shift and all the other complaints all go away. If you get to the source you don't have to treat all those other things. Typically a person has a layer of problems as time goes on. Their body mind spirit is ready to shift on some certain level. You will know by the palpation of the abdomen keeping your mind open and listening for the deepest reaction at any one moment. According to Sun Simo--Massaging the hara after eating will cure all diseases.
(See chart of five elements on abdomen) You'll want to develop some way to make notes of your findings. Susan uses a picture, writes their current complaint and marks the picture with where they say the pain is and what she finds. Next time they come, she looks to see what the differences might be. Every time, the abdominal reactivity should be different.
We're mapping out the reactivity and then to the treatment protocol to see if we can change it. We do that by going to the meridian location, touching it and then rechecking the meridian to see if it's changed. If you can find a point that releases the reactivity right then, it's a good sign that the person is going to react well. If not, it will be slower. If you're sure they have a certain imbalance and you feel something different, go with what you feel.
Sequence: Arms and legs uncrossed. Align and atune. Put hands on abdomen and sense for temperature, firmness, what is the chi doing to the hands--is there more in one place than another? . Put your hand in the fire area and listen to it, comparing to other areas. Think about which element area you are in and which meridians. Kidney is 1/2 cun outside of belly button, stomach is 2 cun out, spleen is 4 cun and liver is 6 cun, but no points on abdomen. When you look at someone's abdomen you have to pretend you see those lines. When we're palpating, we go down on the left and up on the right, because of the way the intestinal paristalsis goes. We want to palpate so as not to force the peristalsis to go in reverse. In diagnosing, mark the diagram where they say the pain is and what reactivity you find. It should shift.
Start with CV meridian at the xyphoid process going from up to down. Start with light pressure and then specifically to the meridian, 3 fingers at a time. Ask them if there's anything that feels sharp, numb, weird, etc. You are thinking, what am I feeling and how deep can I go. Don't go deeper than a couple of finger depths. If there's something there, they'll notice and/or you will. Note the point that gets a reaction--you can mark it on their skin. Go all the way to the pubic bone if they'll let you. Don't push inside the belly button.
Line 2 is kidney on the left, from top to bottom. Stomach is line 3, on the left, top to bottom. Then liver, 2 more cun out, the same way. Line 5 is kidney on the right from bottom to top. Line 6 is stomach, going up from pubic bone to ribs. Line 7 is spleen, going up. Continue according to the chart.
Thengo under the ribs, feeling for tension, tight muscles. Go from below and push fingers up, feeling for something pushing back (the diaphragm).
Then the superior iliac crests, the front of the hip bones (GB meridian). That tells how well the chi is flowing from the legs. Find the hip bone and palpate under, feeling for tension, ticklishness, tenderness, etc.
Last do the mu points that aren't in that part of the abdomen: Lu1, CV17, Liv14, and G25. If liver 14 isn't tender, touch them on both sides and ask if one side is different from the other--signifies deficiency.
