Diagnostics in Chinese Medicine Book and Dvd by Chen Jia-xu & Jane Frances Wilson

Author:Chen Jia-xu & Jane Frances Wilson
Language: eng
Format: mobi, pdf
Publisher: 人民卫生出版社
Published: 2016-05-04T16:00:00+00:00

Section 2 areas for palpatory examination

The areas that are suitably included in the palpatory examination include palpating the chest and hypochondrium, abdominal area, skin, hands, feet, and acupuncture points particularly the transport points, etc.

1. Palpating the chest and hypochondrium

The chest refers to the area from the supraclavicular fossa to the bottom of the ribs. The hypochondrium is also called the rib-side, and relates to the area on both sides of the chest, from the armpit to below the eleventh or twelfth ribs.

Palpating the chest and hypochondrium is mostly used to examine the pathological changes of the heart, lung, liver and gallbladder.

(1) Palpating the chest

Palpating the chest can help to understand the changes of the heart, lung and to assess the throbbing of the left ventricle of the heart or apical pulse (xū lĭ).

A. Protruding or bulging of the chest walls with clear sound when tapped indicates lung distension or pneumothorax.

B. Distending pain after palpating the chest, with dull sound, suggests retention of fluid in the chest or phlegm-heat obstructing the lung.

C. Protruding or bulging chest with possible barrel-chested appearance, deep breathing, irregular and rapid pulse, is the forerunner of heart and lung qi exhaustion.

D. Local tenderness, swelling, and an aversion to pressure indicate thoracic injury.

Palpating xū lĭ (apical pulse):

A. Location:

Below the left nipple, between the fourth and fifth ribs is the apex point (heart apex).

B. Physiologic characteristics:

Pulsation is palpable but not strong, range of fluctuation about 2~2.5 cm, beating smoothly, moderately and rhythmically.

C. Clinical significance:

Detecting whether the zong qi is strong or weak, the disease is deficient or excessive or if the prognosis is favourable or unfavourable.

D. Method:

The patient lies on their back; the practitioner stands beside the patient’s right side and touches his apical pulse gently with the right hand.

Clinical significance of abnormal changes of the apical pulse:

① Weak beats mean deficiency of the zōng qi.

② Strong beating and vibrating of the clothes indicates outburst of zōng qi.

③ Occasional and intermittent fast beats suggests failure of middle qi to keep in its place.

④ Slow and feeble beats or fast beats, because of weakness due to chronic diseases, governs insufficiency of heart yang.

⑤ Protruding or bulging chest with dyspnoea and scattered and fast beats, indicates exhaustion of the heart and lung qi.

⑥ Weak beating, with no fatal symptoms, is mostly due to phlegm-retention.

Attention: The factors, other than pathogenic factors that influence the apical pulse beating include: fright, great anger or violent thoughts, exercise, and obesity.

(2) Palpating the hypochondrium

Palpation of the hypochondrium can help detect pathological changes in the liver and gallbladder.

A. Distending pain on both sides, involving the lesser abdomen, indicates constraint of liver qi.

B. Distending pain in the right rib region and heat sensation, which the patient is reluctant to have pressed, are signs of a liver abscess.

C. Hypochondriac pain, which the person likes to have pressed and demonstrates vacuity and weakness when being pressed, indicates liver deficiency.

D. Hypochondriac lumps with stabbing pain and dislike of pressure, indicates blood stasis.

E. Right hypochondriac lumps, which are hard and uneven, is possibly liver cancer.

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