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DIAGNOSIS BY PALPATION

DME-312 HANDOUTS 7,8,9

PALPATION
Diagnosis by feeling generally includes the following Palpation of the pulse Palpation of the skin Palpation of the limbs

Palpation of the hands


Palpation of the chest Palpation of the abdomen Palpation of the points

PULSE DIAGNOSIS
Performed by placing fingers along the Radial Artery.

Pressure is applied with different kinds of strength at three different points.

The patients arm should be horizontal and not held higher than heart level.

PULSE DIAGNOSIS
We use the pads of the fingers to take the pulse because they are the most sensitive area.

We place the first three fingers (not counting the thumb) on the Radial artery.

PULSE DIAGNOSIS
Pulse is felt by moving the fingers in 4 different ways:
Lifting (upwards) Pressing (downwards) Pushing (side to side) Rolling (proximal distal)

We also keep the fingers still (searching) in order to be able to decide the speed of the pulse.

PULSE DIAGNOSIS
Sections of Pulse Inch (CUN) - Front Barrier (GUAN) - Middle Cubit (CHI) - Back

Pulse Depth Superficial resting fingers very gently on the artery Deep almost obliterate pulse then release very slightly

Middle in between these two kinds of pressure

Altogether, 3 Sections x 3 Depths = The 9 Regions

PULSE DIAGNOSIS

Correspondence of each organ and section / level according to the Mai Jing (Pulse Classic)

PULSE DIAGNOSIS
Main importance of Pulse Diagnosis 1. Gives detailed information about state of internal organs 2. Reflects whole complex of Qi and Blood

Other Notes
Pulse counts as a clinical manifestation that shows you the entire body The tongue also does this, but with less clarity

PULSE DIAGNOSIS
Drawbacks to Pulse Diagnosis Extremely subjective Skill is subtle and hard to master Subject to external, short-term influences

Advantages to Pulse Diagnosis It can reflect older disharmonies not showing on tongue, as well as others due to discoloration or physical manipulation of it (such as scraping)

PULSE DIAGNOSIS
What you should pay attention to (IN THIS SPECIFIC ORDER) 1. Feel the Pulse as a whole 2. Feel whether the pulse has spirit, Stomach Qi and root 3. Feel the three levels and the three positions

4. Feel the strength of the pulse


5. Feel the quality of the pulse

PULSE DIAGNOSIS
Qualities of Pulse that we are looking for Force Movement Rate

Rhythm
Shape Presence of Shen

PULSE DIAGNOSIS
What is a Normal Pulse? Has Stomach-Qi Feels gentle, calm and relatively slow (4 beats per respiratory cycle / breath) Has Spirit Soft but with strength; neither big or small Regulated should not change type very easily Has root

Deep level is clearly felt along with rear position Kidneys are felt strong

PULSE DIAGNOSIS
Factors that affect the Pulse Seasons Pulse is deeper in wintertime; superficial in summertime Gender

Male pulse is naturally stronger than womens Men have stronger left pulse; women, the right pulse Men have stronger front pulse; women, the rear Occupation People who perform strong physical labor should have a stronger pulse than those who do not

PULSE DIAGNOSIS
Factors that affect the Pulse Body build Pulse will be stronger, larger and longer in robust, large people; weaker, smaller and shorter in small, frail people Menstruation Becomes slippery the week before the onset, especially on the right rear position; then it becomes weak and slower Pregnancy Becomes slippery, therefore it is considered normal Fan Guan Mai and Xie Fei Mai These are abnormalities on the pulse

PULSE DIAGNOSIS
Fan Guan Mai is a radial artery displacement that is present in about 5% of people.

The radial artery lies in the dorsal aspect of the arm instead of the inner aspect.

In these cases, the pulses on the nine regions of the head, hand and feet are recommended.

DEEP PULSE
Chinese Name Chen Mai, a.k.a. Sinking Description Can only be felt with heavy pressure; felt near the bone Clinical Significance Indicates an interior condition Indicates the Yin organs to be the problem Indications

Deep and Weak: Yang and Qi deficiency


Deep and Full: a) Stasis of Qi; b) Blood in the Interior; c) Interior Cold or Heat

FLOATING PULSE
Chinese Name Fu Mai Description Can be felt with a light pressure, resting fingers on artery Clinical Significance Indicates presence of exterior pattern from pathogen Indications Floating and Tight: Wind-Cold

Floating and Rapid: Wind-Heat


Floating Superficial / Empty Deep: Yin deficiency

SLOW PULSE
Chinese Name Chi Mai Description Three beats per respiration cycle (breath) of practicioner Can also be counted using a watch Clinical Significance Indicates a Cold pattern Indications

Slow and Empty Empty-Cold from Yang Deficiency


Slow and Full Full Cold

SLOW PULSE
Typical Slow Pulse Speeds (estimated)

Age (Year) 14 4 10 10 16 16 35 35 50 50+

Rate (beat/min) 90 or more 84 78 / 80 76 70 / 72 68

RAPID PULSE
Chinese Name Shu Mai Description 5 or more beats per cycle (or higher than slow chart)

Clinical Significance
Indicates a Heat pattern Indications Rapid and Empty Empty-Heat from Yin Deficiency Rapid and Full Full Heat or Excessive Heat

EMPTY PULSE
Chinese Name Xu Mai (a.k.a. Vacuous, Deficiency) Description Feels rather big, but soft; feels empty with more pressure

Clinical Significance
Indicates Qi or Qi AND Blood deficiency

FULL PULSE
Chinese Name Shi Mai (a.k.a. Excess type, Replete) Description Feels full; rather hard and long

Clinical Significance
Indicates a Full pattern Indications Full and Rapid Full-Heat Full and Slow Full-Cold

SLIPPERY PULSE
Chinese Name Hua Mai Description Feels smooth, round, oily to the touch; rolls under fingers Feels like rolling pearls in a porcelain bowl Clinical Significance Indicates Phlegm, Dampness, Food retention, Pregnancy Indications

Its full by definition, but can be weak as well


It can be weak, indicating Phlegm, Dampness and Qi deficiency

CHOPPY PULSE
Chinese Name Se Mai a.k.a. Hesitant, Rough Description Rough under the fingers; like a jagged edge

Feels like a knife scraping bamboo


Also means a pulse that changes rapidly in rate and quality Clinical Significance Indicates stasis or deficiency of blood Could mean exhaustion of fluids, especially after profuse sweating or vomiting

LONG PULSE
Chinese Name Chang Mai Description Longer than normal; extends slightly beyond normal pulse

Clinical Significance
Indicates a Heat pattern May indicate that there is no Pathological condition

SHORT PULSE
Chinese Name Duan Mai Description Occupies shorter space than normal position

Clinical Significance
Indicates a severe Qi deficiency Frequently appears on Front position; either left or right Specifically denotes deficiency of Stomach-Qi

OVERFLOWING PULSE
Chinese Name Hong Mai, a.k.a. Surging, Flooding Feels big and extending beyond normal pulse position Superficial; generally overflows normal pulse channel Indicates an Extreme Heat pattern Frequently appears during Fever, and Interior Heat diseases Overflowing and Empty on pressure Empty Heat from Yin deficiency Description

Clinical Significance

Indications

FINE PULSE
Chinese Name Xi Mai, a.k.a. Thready, Thin Description Feels thinner than normal

Clinical Significance
Indicates a deficiency of Blood May indicate Dampness with severe Qi deficiency Indications Thin and Rapid Heat brought by Yin deficiency

MINUTE PULSE
Chinese Name Wei Mai, a.k.a. Faint Description Thinner than the Fine pulse; harder to feel; very small

Clinical Significance
Severe deficiency of Qi and Blood

TIGHT PULSE
Chinese Name Jin Mai, a.k.a. Tense Feels twisted, like a thick rope It also can be felt as it vibrates Indicates a Cold pattern, exterior (i.e. Wind-Cold) or Interior May indicate pain from an interior condition Tight and Floating Exterior Cold Tight and Deep Interior Cold Description

Clinical Significance

Indications

WIRY PULSE
Chinese Name Xian Mai, a.k.a. Stringlike, Bowstring Description Feels taut, like a guitar string Thinner, more taut and harder than the Tight pulse No fluidity or wave-like qualities Clinical Significance May indicate Liver disharmony

May indicate Pain


May indicate Phlegm

SLOWED-DOWN PULSE
Chinese Name Huan Mai, a.k.a. Moderate Description Four beats per respiration cycle

Clinical Significance
Generally considered a healthy pulse If Dampness is suspected by other signs, it can be used to indicate its presence

HOLLOW PULSE
Chinese Name Kong/Kou Mai, a.k.a. Scallion-stalk Description Felt at superficial and deep; any middle pressure makes it empty Clinical Significance Indicates a loss of Blood Usually appears after a hemorrhage Indications Hollow and slightly Rapid Forthcoming loss of Blood

LEATHER PULSE
Chinese Name Ge Mai, a.k.a. Drumskin Description Hard, tight and stretched superficially; empty at Deep level

Large pulse, not thin


Clinical Significance Indicates severe deficiency of Kidney-Essence or Yin

FIRM PULSE
Chinese Name Lao Mai, a.k.a. Confined, Prison Description Only felt at Deep level; felt hard and rather wiry

Could be described as a Wiry pulse at the Deep level


Clinical Significance Indicates Interior Cold (if it is also Slow) Indicates Interior Stagnation and Pain

SOGGY PULSE
Chinese Name Ru Mai, a.k.a. Soft, Weak-Floating Description Only felt on superficial level; very soft and slightly floating

Disappears when pressure is applied to feel Deep level


Clinical Significance Indicates presence of Dampness if there are other signs that represent a Qi deficiency May also indicate lack of Yin or Essence

WEAK PULSE
Chinese Name Ruo Mai, a.k.a. Frail Description Only felt on Deep level; also soft

Clinical Significance
Indicates a deficiency of Yang or of Blood

SCATTERED PULSE
Chinese Name San Mai Description Small and relatively superficial

Feels as if it was broken into small dots


Clinical Significance Severe deficiency of Qi and Blood, especially Kidney-Qi ALWAYS indicates a serious condition

HIDDEN PULSE
Chinese Name Fu Mai Description As if it was hidden beneath the bone

Extreme case of Deep pulse


Clinical Significance Extreme deficiency of Yang If strong, indicates an obstruction of Cold

MOVING PULSE
Chinese Name Dong Mai, a.k.a. Spinning-Bean Description It is short and trembles under the finger

Does not have a definite shape; shaking and also slippery


Combination of short, tight, slippery and rapid pulses Clinical Significance Indicates shock, anxiety, fright or extreme pain Found in people with deep emotional problems, especially fear, or those who have suffered severe emotional shock

HASTY PULSE
Chinese Name Cu Mai, a.k.a. Abrupt, Skipping, Hurried Description Rapid pulse, stops at irregular intervals

Clinical Significance
Indicates extreme Heat and a deficiency of Heart-Qi Also felt in conditions of Heart-Fire

KNOTTED PULSE
Chinese Name Jie Mai, a.k.a. Bound Description Slow and stops at irregular intervals

Clinical Significance
Indicates cold Indicates deficiency of Heart-Qi or Heart-Yang

INTERMITTENT PULSE
Chinese Name Dai Mai, a.k.a. Regularly Interrupted Description Stops at regular intervals; feel the pulse and feel the stops

Clinical Significance
Indicates a serious internal problem of one or more Yin organs If it stops every four beats or less, the condition is serious It can also indicate a serious heart problem (in the Western medical sense)

RACING PULSE
Chinese Name Ji Mai, a.k.a. Swift Description Pulse is very rapid, but agitated and very urgent

Clinical Significance
Indicates an Excess of Yang, with Fire in the body exhausting Yin

PULSE DIAGNOSIS
28 Different Pulse Qualities (with similar Grouping) (The groups have been been grouped on a Yin-Yang level)
Deep Deep Floating Floating Slow Slow Rapid Rapid Empty Empty Full Full

Firm
Hidden

Hollow
Leather

Knotted

Hasty
Hurried Moving

Weak
Fine Minute Soggy Short Scattered

Overflow
Wiry Tight Long

PULSE DIAGNOSIS
8 Principles Exterior (Yang) Interior (Yin) Hot (Yang) General Description Pulse Quality superficial deep rapid Felt with light pressure Felt with deep pressure More than 80 BPM (>5 per breath) Less than 65 BPM (3> per breath) Large, long, substancial Small, short, insubstancial Specific Pulse Quality Superficial; floating; hollow; leather; soft Deep; Firm; Hidden Rapid; Hasty; Moving

Cold (Yin)

slow

Slow; Tight; Knotted; Intermittent (not necessarily slow but often) Full; Big; Overflowing; Wiry; Tight; Long; Slippery; Flooding; Empty; Weak; Fine; Minute; Short; Scattered; Choppy

Full (Yang)

full

Empty (Yin)

empty

SKIN PALPATION
Palpating the skin involves focusing on three major topics: Temperature of the skin Moisture of the skin Texture of the skin

We do this by three different methods: Touching Stroking Pressing

PALPATING THE BODY


There are three different palpation techniques: Touching - Light touch of the patients skin Detecting temperature, moisture and sweat Stroking stroking in the skin and deeper tissues of the patient Usually carried out in chest, abdomen and limbs Determines presence of tenderness and swelling Pressing pressing relatively hard to deeper levels

Usually done in the abdomen Determines presence of pain or masses

SKIN PALPATION
Key things to Know Temperature Subjective feeling of heat does not always correspond to the objective feeling of heat of the skin Skin feels hot to the touch often indicates Damp-Heat Cold feeling indicates Cold pattern; often felt in loins, lower abdomen or lower back (indicates Kidney-Yang deficiency) Hot on first touch, ceasing to feel hot with sustained pressure indicates Wind-Heat invasion, still on exterior Skin over vessel hot on medium pressure but not on heavy pressure interior Heat in Middle Jiao or Heart Skin hot on heavy pressure nearly nearing the bone Empty Heat from Yin deficiency

SKIN PALPATION
Key Things to Know Moisture and Texture Moist skin may indicate invasion of the Exterior by WindCold, or more commonly, Wind-Heat Moist skin with absence of exterior symptoms indicates spontaneous sweating from Lung-Qi deficiency Dry skin indicates Blood or Lung-Yin deficiency Rough-like skin may indicate Painful Obstruction Syndrome from Wind Scaly and dry skin indicates exhaustion of body fluids Swollen skin with a pit left after pressing indicates oedema Swollen skin, no pit indicates retention of Dampness

LIMB PALPATION
Key Things to Remember: Hands and feet cold to the touch indicate Yang deficiency Whole arm and leg feel cold indicate Kidney-Yang deficiency (Empty-Cold) Only forearm and lower leg feel cold may indicate Interior Cold from Qi stagnation (Full-Cold) Only hands and feet feel cold may indicate Qi stagnation Limbs feeling hot indicate a Heat pattern Hands hot on the dorsum indicate Full-Heat Hands hot on palms indicate Empty-Heat from Yin deficiency

CHEST PALPATION
Process Palpate the area over the left ventricle of the heart (called Interior Emptiness or Xu Li in Chinese Medicine) Pulse of heart can be felt in this area; sometimes seen Area reflects the state of Zong Qi (Gathering Qi)

CHEST PALPATION
Key Things to Remember Faint but clear pulsation indicates Gathering Qi deficiency Too strong pulsations indicate outpouring of Gathering Qi, i.e. a state of hyperactivity due to over-pushing oneself Pulsation not felt indicates Phlegm or a hiatus hernia Area below xyphoid process feeling full and painful on pressure indicates a Full pattern

ABDOMEN PALPATION
The Abdomen is generally palpated in 5 areas: Hypochondrium Epigastrium Umbilical area

Lateral-lower abdomen
Central-lower abdomen

ABDOMEN PALPATION

Hypochondrium Includes the lateral side of the rib cage and area immediately below it Reflects state of the Liver and Gall-Bladder

ABDOMEN PALPATION

Epigastrium Area contained between the xyphoid process, costal margins and the umbilicus Reveals the condition of the Stomach and Spleen

ABDOMEN PALPATION

Umbilical Region It is the area right around the umbilicus It reflects the state of the Kidneys, the Penetrating and Directing Vessels

Umbilical area has a palpable pulse as well

ABDOMEN PALPATION

Lateral-lower Abdomen Also called Shao Fu

Reflect the state of the Intestines and the Penetrating Vessel

ABDOMEN PALPATION

Central-lower Abdomen Also called Xiao Fu

Reflects the state of the Small Intestine, Kidneys, Bladder, Uterus and Liver

JAPANESE HARA DX
Step 1: Compare Big and Small Abdomen Big Abdomen Deficient LU or SP Small Abdomen Deficient LV or KD

JAPANESE HARA DX
Step 2: Determin Nan Jing Abdominal Diagnosis Area: SP Umbilical, CV7 CV12 HT Substernal, CV12 CV15 LU Right of Navel / Right Ab LV Lower left of Navel / Left Ab

KD Subumbilical, CV7 Pubis

POINT PALPATION
Main point of point palpation is checking for tenderness Very tender on superficial pressure Full condition on that channel or local stagnation Pressure relieves pain Empty condition on that channel Pressure relieves but then causes discomfort mixed Deficiency and Excess condition

All acupuncture points (and Ah Shi points) can be used diagnostically.

POINT PALPATION
Main Points for Palpation Diagnosis Front Collecting (Mu) Points Back Transporting (Shu) Points Lower Sea Points

Source (Yuan) Points


Ah Shi Points

FRONT MU POINTS

Mu raise, collect, enlist, recruit

Points where the Qi of the relevant organs get collected

BACK SHU POINTS

Points are all located on the Bladder channel

Reflect specifically the condition of the relevant internal organ instead of its channel

BACK SHU POINTS

LOWER SEA POINTS


Points are used to treat their respective Yang organs

Organ L.Int. San Jiao S. Int.

Point ST-37 UB-39 ST-39

Channel Yang Ming Shao Yang Tai Yang

Organ Stomach Gall-Bladder U. Bladder

Point ST-36 GB-34 UB-40

YUAN POINTS

If the 5 Yin organs are diseased, abnormal reactions will appear at the 12 Source points. If we know the correspondence of Source points to the relevant Yin organ, we can diagnose when a Yin organ is diseased.

Spiritual Axis, Ch. 1

YUAN POINTS
Source Points for the Yin Organs
Yin Organ Lungs Heart Spleen Liver Source Point LU-9 Taiyuan PE-7 Daling SP-3 Taibai LIV-3 Taichong

Kidneys

KI-3 Taixi

AH SHI POINTS
Ah Shi Theory If there is soreness on pressure (whether on a channel or not), there is a point Body is completely covered by different channels so every area is irrigated by them Pressure and description of the condition will reflect the channel which it is closest to

REFERENCE / CREDITS
Kaptchuk, Ted - The Web that has no Weaver Maciocia, Giovanni Diagnosis in Chinese Medicine Maciocia, Giovanni Foundations of Chinese Medicine Xin Nong, Cheng Chinese Acupuncture and Moxibustion Zheng, Li Shi - Pulse Diagnosis Flaws, Bob The Secret of Chinese Pulse Diagnosis