Palpating the Skin and Muscle

Generally, if there is excessive pathogenic heat in the body, the patient will usually have heat on the body surface. Yang qi deficiency has a cold body surface on palpation. If the surface feels hot on first palpation becoming slightly hotter when you palpate longer, this indicates that the pathogenic heat has proceeded from the exterior to the interior of the body. Body palpation showing moist and smooth skin demonstrates that the body fluid is not yet damaged. If the skin and nails are very dry, this indicates consumption of the body fluids. If body palpation shows swelling and further pressure makes a depression, this indicates edema. If a depression appears on pressure and disappears after taking the hand away, this indicates qi distension. Palpating the skin can also indicate the patient's sweat condition.

Palpating Hands and Feet

Coldness of the four extremities is mostly due to yang deficiency and excessive pathogenic cold. An overheating of the four extremities indicates excessive heat. Coldness of the four extremities with heat in the chest and abdomen is due to the retention of internal heat preventing the flow of yang qi outward. Heat in the dorsum of the hand is a sign of disease caused by exogenous pathogenic factors.

Palpating the Epigastrium and Abdomen

If the patient has fullness and distention of the hypochondrium, palpation may demonstrate hardness and pain in this region. This is known as an accumulation of excessive pathogenic factors in the chest of the xu type. If the hardness extends over a large area in the chest, it is due to phlegm-humor.

Palpation of the abdomen showing abdominal distention with a tympanitic note on percussion, but with normal urination, indicates qi tympanites. Abdominal distension with a splashing sound like water, and accompanying dysuria indicates was tympanites or ascites. If hand pressure relieves the abdominal pain, it is considered to be a xu type; if the pain is made worse by pressure, it is a shi type. Immovable hard masses in the abdomen with pain fixed in a certain area are due to blood stasis. However, if the patient feels that lumps sometimes appear and disappear with unfixed pain, and palpation of the abdomen shows they do not exist, then this is due to qi stagnation.

Palpating Channels and Points

Clinical practice proves that in some diseases there may occur tenderness or abnormal reactions along the courses of the affected channels or at certain points. These signs have significance in diagnosis by palpation, especially in acupuncture treatment. For example, there may be tenderness at Pt. Zhongfu or Pt. Shufu, which are closely related to the disorders of the lung and trachea. In diseases of the heart and stomach, tenderness may occur at Pt. Jugue of Ren, Pt. Zhongwan of Ren, Pt. Burong, or Pt. Liangmen. In disorders of the liver and gall bladder, tenderness may be at Pt. Qimen and Pt. Riye. In diseases of the spleen, tenderness may occur at Pt. Zhangmen and Pt. Huangmen. In disorders of the kidney, Pt. Jingmen and Pt. Zhishi may have tenderness. Tenderness at Pt. Tianshu. Pt. Daji and Pt. Fujie may be closely related to disorders of the intestines. Tenderness at Pt. Guanyan, Pt. Qihai and Pt. Zhongji may have a close relation with disorders of the urinogenital system. When there are abnormal reactions appearing at the above points, they may reflect pathological changes of the related zang or fu organs.