The basics of abdominal palpation – smart health with Traditional Chinese Medicine
Palpation consists of TO TOUCH and to PRESS the surface tissues of the body to determine the location and nature of the pathology. By touching, you can assess the temperature and the degree of humidification. By the PRESSURE, we appreciate the tone, the presence of pain on pressure and – the hard areas (balls, masses, nodules).
What you will learn
Inspection and clinical palpatory medical examination
The classic medical clinical examination consists of approaching the abdomen by palpation in order to assess the tone of the visceral walls; percussion to locate and size the organs and auscultation to assess the circulation of air, blood and bile flows.
Epigastrium: stomach, duodenum, pancreas, heart, pericardium (atypical pericarditis causes epigastric pain).
Right hypochondrium: pleura and lung, liver, gallbladder.
Left hypochondrium: pleura and lung, spleen.
Umbilical region: pancreas, mesentery, aorta, small intestine.
Right flank: liver and its downward radiation, colon, right kidney and ureter.
Left flank: left colon, kidney and ureter.
Hypogastrium: bladder, left right colon and rectum, ovaries, uterus and appendages, testes, ureter.
Right iliac fossa: cecum, worm-shaped appendage, right ovary.
Left iliac fossa: sigmoid colon, left ovary.
The standard procedure for abdominal diagnosis
1. The hands are enough
hot.
2. The patient should have some time to relax. The practitioner must also be calm and serene.
3. The practitioner must position himself on the left side of the patient.
4. The patient lies on his back, knees stretched naturally, hands close to the thighs. (Patients who are used to being examined by doctors tend to bend their knees, but this is not an examination of the internal organs, so the legs should be fully extended.) The entire torso should be exposed.
5. Once the patient is relaxed, the practitioner observes the respiratory movement on the chest and abdomen. Any visible movement around the heart and the presence of pronounced asymmetries in the chest and abdomen are noted.
A flexible and toned abdomen, without painful tenderness, is normal. The skin is elastic, fluffy, slightly shiny.
When a person is healthy, the skin of the abdomen is smooth and uniform from top to bottom, and the abdominal wall is flexible and resilient like a rubber ball. The skin of the abdomen should have luster, and should not be too dry or too wet. The surface of the abdomen should be warm and no particularly hot or cold areas should be felt. A healthy abdomen has no tender points, indurations or strong pulsations.
Honma Shohaku
6. The practitioner begins to palpate the areas around P1 in the subclavicular pits using the palmar surface of the fingers of the right hand. An abundance of Lung Qi is indicated when the upper thoracic area is large, the flesh is abundant and the area is firm to the touch. Deficiency in lung Qi is indicated when the skin is dry, the flesh is soft, or the upper ribs can be easily seen or felt.
7. The general condition of the abdomen is then checked by touching the midline, passing over the upper abdomen, the navel and the lower abdomen (when a strong pulse can be felt throughout the middle line from Ren 15 to Ren 6 the patient should be referred to a doctor).
8. The state of the meridian of Heart is palpated in the epigastric region. The area between Ren 15 and Ren 12 should be slightly concave. This area should be flexible but resilient, and there should be no noticeable pulsation. If you can feel a strong pulse or if the area is hard, the Qi of the heart is deficient.
9. The state of the meridian of the Missed is palpated in the area between Ren 12 and Ren 9. The spleen and stomach are normal when this area is resilient but not hard. Spleen Qi is deficient when it is soft, or like a plastic bag filled with water, or when the patient is extremely ticklish.
10. The state of the meridian of Kidney is palpated in the hypogastric region around Ren 6. The Kidney Qi is abundant when this area is resilient and protrudes slightly from the upper abdomen. Kidney Qi is deficient when the area under the navel is depressible or cold, or when a band of tension can be felt deep. A strong pulse in this area is also a sign of impairment. (It is normal for a slight pulse to be felt when applying light pressure. This is the "pulsation between the kidneys" described in Nan Jing.)
The pulsation (literally, the displacement of Qi) between the kidneys (located) below the navel reflects a person's vitality. It is the root of the twelve meridians. It is therefore called the source of life.
Nan Jing, 66th difficulty
11. The condition of the liver meridian is palpated in the flank regions, the areas located on the sides of the abdomen prior to VB 26. When the liver meridian is normal, the flesh in the flank regions is large and muscle tone is good. When the flank regions are empty and lack tone, this is a sign of liver failure. It is said that a lack of muscle tone around F13, which allows the fingers to be easily pressed under the rib cage, is an imminent sign of stroke.
The epigastric region around Ren 14 should be flexible and the lower abdomen around Ren 6 should be firm. When the epigastric region is tight there is a tendency for the lower abdomen to be soft and depressible.
The skin of the abdomen should have luster and be very warm. Appearance and surface texture are very important in abdominal diagnosis.
To palpate the abdomen, the hand must
be slightly flared, and the abdomen should be gently "caressed"
with the fingers. The abdomen must first be palpated very gently to
inspect the condition of the skin in order to detect a deficiency or excess
of Qi. After having palpated the abdomen over its entire surface, we exert a slight
pressure with the fingertips to search for sensitivity,
abnormal indurations and pulsations.
The clinical signs of Western medicine, such as enlarged organs or rebound sensitivity, should also be noted. Patients with acute abdominal signs should seek immediate medical attention.
The results of the examination of
the abdomen should be correlated with the six-position pulse diagnosis.
For example, when the pulse diagnosis indicates impaired
Lung, signs of impairment should be detected in the diagnostic area
of the lung, and similar signs should be detected in the area of
diagnostic of the spleen.
When a lung deficiency is
proven treatment is to tone P9. This should affect
immediately pulse (i.e. increase its strength to the Lung position)
as well as improving the condition of the abdomen in the diagnostic area of the lung.
Rte3 should also improve the quality of the pulse and the state of the abdomen
around the navel.
There is a direct correlation between the pulse and the abdomen.
What is sought by the abdominal diagnosis are the changes in Qi and the practitioner should not therefore press very hard to perceive them. The use of excessive pressure makes it difficult to perceive subtle changes on the surface of the abdomen.
Abdominal diagnosis in Nan Jing
The first text to describe the importance of abdominal palpation is Nan Jing, in chapters 8, 16 and 56.
In chapter 16 of Nan Jing we find indications on pulsating sensations, the presence of induration and a tenderness of the abdomen with reference to the diagnosis of the 5 Zang.
A pathological pulse must be accompanied by the corresponding signs and symptoms before a specific diagnosis can be confirmed.
The 56th Nan Jing difficulty describes pain localized on the abdomen, "accumulations" produced by the 5 YIN viscera which are according to the 55th difficulty of "pains permanently localized and which indicate that the disease is deep, hidden, of well defined localization". For example :
Accumulation of the liver is called fatty energy, which occurs under the left ribs, in the shape of an inverted cup, like the head and foot, and is chronic in nature, causing symptoms such as cough, qi ni, malaria. general, for many years; these diseases occur on Wu and Ji days during the extended summer. What does it mean?
Lung disease is transmitted to the liver and liver, it is transmitted to the spleen and the spleen is under the extended summer reign and as the kingdom organ is immune to the disease, the disease is once again transmitted from the liver to the lungs, but the lungs refuse to accept it, so it stagnates to become an accumulation.
This is why we know that fatty energy will occur on Wu and Ji days during the extended summer.
Nan Jing 56 – About diseases of accumulation of the five viscera
“When the pulse of the Heart is present, there are external signs of a red complexion, a dry mouth and a tendency to laugh. The internal signs are a pulsation in the area above the navel and (this area) is hard or painful when pressed. There is restlessness and pain in the heart, heat in the palms of the hand and dry vomiting. Those in whom these signs are seen have heart disease. "
“When the pulse of the spleen (moderate) is present there are external signs a yellowish complexion, belching, a tendency to think too much, and a penchant for overeating. The internal signs are a pulsation in the area above the navel, and (this area) is hard or painful when pressed. There is distension and fullness of the abdomen, food is not digested, feeling of heaviness in the body, pain in the joints, fatigue and lethargy, desire to lie down and inability to bring the limbs back to the body. Those with these signs have Spleen Disease. "
“When you perceive a (floating) pulse there are external signs of a white complexion, a tendency to sneeze, melancholy and a lack of joy, a desire to cry. As internal signs, there is a pulsation to the right of the navel and this area is either hard or painful when pressed. There is shortness of breath, cough, wheezing, tremors due to fever and chills. Those who have these signs have lung disease. ”
"When the kidney pulse is felt (overwhelmed) the external signs are a dark complexion, a tendency to be afraid and frequent yawning, while the internal signs are a pulsation under the navel and this area is hard or painful when it is hurry. With this disease, Qi rushes to the head, there is tension and pain in the lower abdomen, diarrhea with feeling of heaviness in the intestines and feeling of cold and rebellion in the lower limbs. Those who have these signs are suffering from kidney disease. "
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