Success with Palpation & Pulse Diagnosis

            Diagnostic methods like palpation and pulse diagnosis are common tools used by acupuncturists across the globe for centuries. Both palpations on the body as well as pulse diagnosis allow acupuncture providers to determine changes in the body as well as the location and nature of the condition. Over the years, palpation and pulse diagnosis has been studied as to the efficiency of palpation and pulse diagnosis for various conditions. In the world of traditional Chinese medicine as well as in Japanese acupuncture, palpation and pulse diagnosis are helpful tools in treating patients day to day, and getting to the root issue as acupuncture is famous for.

Palpation on the Body

            Palpation allows for the acupuncture provider to determine a multitude of facts regarding the presenting condition in the patient. Touching, pushing, pressing, and feeling on various parts of the body in the patient allow for us some insight into the nature of the illness.

Possible indications received from palpating the following parts of the body:

• Acupuncture Points/Channels – qi of the organs meets at the acu-points, and palpating at these points can indicate illness to the acupuncturist. An atypical or pressure point pain can reflect disease of the particular organ being palpated.
  
  
• Muscles & Skin – palpating these areas help indicate the pathogens that have taken over the body or yang qi. When yang qi is drained the temperature is low, and the opposite is true if yang qi is in excess. The acupuncture provider should feel for feverish, moist, dry, cold, or swollen skin and/or muscles to find out where the patient condition lies.
  
  
• Hands & Feet – palpating the extremities and feeling coldness or hear are indicative of either excessive pathogenic cold or excessive heat.
  
  
• Abdomen & Chest – there are many important organs that take up residence in these areas, not least of which being the heart. When palpating here, the acupuncture provider should be looking for heat, pain, fullness or hardness which will indicate which organ isn’t functioning optimally.

Although many acupuncturists utilize palpation all over the body, there are also a great deal that believe any patterns of disharmony can be retrieved through palpation of the abdomen and exist in the organ systems. A well-known palpatory technique is in the realm of Japanese acupuncture also known as Hara diagnosis. Essentially, when utilizing this palpatory technique, the acupuncture provider should be able to palpate to the depth of one knuckle with no pain felt by the patient. If there is pain, this can signal that there is an imbalance.

Palpation locations according Hara Diagnosis:

• Large Intestine – inside the left iliac
  
  
• Small Intestine – inside the right iliac
  
  
• Bladder – on the midline just above the pubis
  
  
• Kidney – on the midline just below the umbilicus
  
  
• Liver – superior to the iliac crest and on the left superior the line of the umbilicus.
  
  
• Lung – right side of the umbilicus
  
  
• Gall Bladder – medial to the nipple line at the 11^th level of the ribs
  
  
• Spleen – on the center line at the 10^th level of the ribs
  
  
• Stomach – on the center line at the 8^th level of the ribs
  
  
• Heart – below the xyphoid process

Hara Diagnosis Protocol:

• Gently touch the area of concern, and let the patient know you will be palpating in that area using both hands. One hand, the stabilizing or mother hand and the messenger hand. The mother hand will remain supportive on the rib cage while the messenger hand moves around the hara using the index, middle, and ring fingers.
  
  
• The palpation should be slow, and begin the finger pressure on the patient’s exhale pressing to the depth of one knuckle without resistance.
  
  
• The messenger hand is utilized as the diagnostic touch finding out the nature of the area rather than pressing deeply.

In addition to the feeling of the palpation areas in both palpation of the body and hara diagnosis, it is important to listen for sounds as well as reactive sensations. These can include fluid sounds and reactions from being palpated that seem to travel to various areas. Essentially, anything the acupuncture provider finds or feels has significance to the overall diagnosis. The same can be said of pulse diagnosis which is a major part of TCM diagnosis.

Pulse Diagnosis Indications

            Every organ’s condition is monitored in TCM through the quality of the pulse. The pulse depicts for the acupuncture provider if the energy in the organ has stagnated or completely lacking energy, if it is lacking blood, or if an external pathogenic factor has entered the organ. While the heart rate and radial pulse is also reviewed, and depending on the medical book looked at, there are said to be anywhere from 12 to 40 pulse qualities that can be assessed in TCM pulse diagnosis. However, most TCM practitioners will usually agree in the realm of 24 to 28 pulse types. Each pulse quality relates to both physical and emotional/mental symptoms as well as a TCM diagnosis.

Most Common/Important Pulse Qualities:

• Strength
  
  
  • Weak pulse – indicates a deficiency in the body which often presents with weakness, insomnia, fatigue, depression, and low blood pressure.
    
    
  • Strong pulse – indicates an excess in the body which often presents with high blood pressure, headaches, anger, and stress.
    
    
• Rate
  
  
  • Slow pulse – indicates a particular body system that is not functioning efficiently as well as a cold condition. This often presents with cold extremities and problems with blood circulation.
    
    
  • Fast pulse – indicates excessive heat, and usually presents when there is increased stress on the nervous system, when there is a fever, or an inflammatory condition.
    
    
• Width
  
  
  • Rolling/Slippery pulse – more common wide pulses and feels like small beads underneath the fingers when taking the pulse, and hints at a buildup of phlegm and food stagnation in the intestines. This pulse presents with digestive issues and congestion issues.
    
    
  • Thin/Thready pulse – indicative of blood or fluid deficiency. This pulse usually presents with weakness, nutrition deficiency, weakness, fatigue, and poor digestive absorption.

Pulse attributes such as pulse length, depth, and quality will tell an acupuncture provider about the patient’s wellness. Both the pulse diagnosis and palpations on the body helps the TCM provider to choose the proper treatment plan to suit the needs of the patient. Since TCM providers are so efficient at determining the underlying root cause of a patient’s condition, it is not surprising that additional techniques like palpation and pulse diagnosis are utilized to form the most appropriate acupuncture or herbal treatment for the patient.