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PALPATION
Diagnosis by feeling generally includes the following Palpation of the pulse Palpation of the skin Palpation of the limbs
PULSE DIAGNOSIS
Performed by placing fingers along the Radial Artery.
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
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
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
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
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 PULSE
Typical Slow Pulse Speeds (estimated)
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
CHOPPY PULSE
Chinese Name Se Mai a.k.a. Hesitant, Rough Description Rough under the fingers; like a jagged edge
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
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
FIRM PULSE
Chinese Name Lao Mai, a.k.a. Confined, Prison Description Only felt at Deep level; felt hard and rather wiry
SOGGY PULSE
Chinese Name Ru Mai, a.k.a. Soft, Weak-Floating Description Only felt on superficial level; very soft and slightly floating
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
HIDDEN PULSE
Chinese Name Fu Mai Description As if it was hidden beneath the bone
MOVING PULSE
Chinese Name Dong Mai, a.k.a. Spinning-Bean Description It is short and trembles under the finger
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
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
ABDOMEN PALPATION
ABDOMEN PALPATION
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
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
POINT PALPATION
Main Points for Palpation Diagnosis Front Collecting (Mu) Points Back Transporting (Shu) Points Lower Sea Points
FRONT MU POINTS
Reflect specifically the condition of the relevant internal organ instead of its channel
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.
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