When it comes to palpating in Traditional Chinese Medicine (TCM), we refer to both the palpation of certain areas of the body and the Chinese pulse. If it seems obvious that palpation can be useful in the diagnosis of musculoskeletal disorders, for example, it is more difficult to imagine that the taking of the pulse or that the specific examination of certain points of the abdomen or the back could be indicative of internal organic problems. However, taking the pulse has long been, along with the examination of the tongue, the privileged tool of the great masters of TCM to make their diagnoses – the interrogation phase can be reduced to just a few questions.

The development of pulse energy diagnosis was fostered under the Confucianist Han dynasty (206 BC – 23 AD), at a time when modesty required minimal physical contact between physician and patient. The taking of the pulses was then the only accepted palpation technique, and it has thus become very refined and precise.

Radial pulses

The six radial pulses are taken at three points located on the radial arteries of each of the two wrists. They each reflect the energetic state of an Organ. The practitioner places three fingers on a wrist and palpates each position with variable pressure:

• The index finger is placed at the “thumb” position, so called because it is closest to the thumb. We feel the Qi of Heaven, that is to say that of the Organs of the Upper Hearth (see Triple Heater): on the right wrist, the Qi of the Lung, and on the left, that of the Heart.
• The ring finger is placed at the “cubit” (a few centimeters further) and accounts for the lower focus where the Qi of the Earth originates. It provides information on the state of Kidney Yin on the left, and Kidney Yang on the right.
• Between these two fingers, the middle finger is located in the “barrier” position, the hinge between Heaven and Earth, where Man flourishes. It assesses the state of the organs of digestion, housed in the middle hearth, the Spleen / Pancreas on the right and the Liver on the left.

This way of taking the pulse is not the only one, but it is the most commonly used today.

Each pulse is assessed in three different ways – depending on the pressure exerted – which requires a great deal of skill on the part of the practitioner. Palpation of the superficial level requires light pressure with the fingers. It reveals Surface diseases as well as the state of Qi and Lung. For example, it is this pulse which will reveal that a person is in the first stage of a cold and that the Qi of his Lung must fight against an external Wind. The deepest level is palpated by exerting strong pressure on the artery, followed by a slight relaxation. It provides information on the state of Yin and more particularly on the Kidneys. Between the two is the intermediate pulse, corresponding to the Qi of the Spleen / Pancreas and the Stomach and the state of the fruit of their production, the Blood.

To these aspects are added characteristics such as rhythm, strength and texture, which will classify the pulse within the 28 (or 36, depending on the author) broad categories of qualities. The types of pulse thus listed are often distinguished by contrast from one quality to another, but can also express a specific quality. From these qualities will be deduced various characteristics, such as Heat, Excess, Stagnation, etc. which will fit within the diagnostic analysis grids. Here are some examples :

• A rapid pulse (more than five beats per respiratory cycle) reveals the presence of Heat. On the contrary, a slow pulse is associated with Cold.
• A string pulse is a hard, narrow pulse that feels like a guitar string stretched under the fingers. It signs the imbalances of the Liver. This is the pulse that we find in Mr. Borduas who suffers from headaches due to Stagnation of the Qi of the Liver.
• A thin pulse, as we find in many cases (see Depression, Slow Digestion, or Tendonitis), is associated with Emptiness of Blood. Barely the width of a wire, it is noticeable, but has very little strength.
• A slippery pulse gives the sensation of pearls rolling under the fingers, it is creamy and smooth, all in roundness. It is a sign of Moisture or Stagnation of food. It is also the pulse of the pregnant woman.
• In contrast, a rough pulse gives the sensation of something scraping the fingers, and is an indication of Emptiness of Blood.

Peripheral pulses

The use of peripheral pulses, nine in number, preceded that of radial pulses in Chinese medicine. By palpating the pulses of the carotid artery, the femoral artery or the foot artery, Chinese doctors could check the state of Qi on a particular meridian, often on a specific acupuncture point. The more convenient radial pulse measurement, however, has supplanted the use of peripheral pulses and few acupuncturists use them systematically.

The necessary discernment

The pulse is a diagnostic element, the subjectivity of which should not be neglected. This subjectivity can come as much from the experience of the practitioner as from his personal dispositions or even from a simple detail such as the temperature of the fingers … We must also know that the pulse reflects the immediate state of the patient, which can be affected by unusual emotions, a more hectic pace of life than normal, physical activities prior to his visit, what he has just eaten or even white coat syndrome …

Pulse characteristics can vary very quickly depending on external point factors. They provide very valuable information, but this must be corroborated by other elements of the review. On the other hand, they have the advantage of allowing practitioners to quickly verify the effectiveness of a treatment. As Dr Yves Réquéna puts it so well: “What is the greatness of a medical art is at the same time its weakness. “1

Palpation of areas of the body (especially the abdomen and back), just like taking the pulse, gives information about the state of imbalance of an Organ or Meridian. The degree of resistance offered or the pain caused by palpating different areas of the body may indicate Excess or Emptiness. The points which, when felt, can cause pain are called Ashi. Dull pain signals Emptiness while sharp pain is associated with Excess. The temperature of the skin and its moisture can also be revealing.

In addition, the specific palpation of certain Meridians makes it possible, among other things, to determine which acupuncture points may be useful for treatment, particularly in cases of musculoskeletal pain. Modern trigger point theory – which is often found at the location of acupuncture points – allows us to suspect that Chinese medicine was not totally ignorant of the mechanism of muscle chains (see Tendinitis).

Palpation of the abdomen

The abdomen is examined in two stages. First, we palpate the Mu points (see photo) which specifically give access to the Yin energy of each of the viscera. These points are found on the anterior side of the body (the Yin side). In general, we can say that when a Mu point is painful, it is the structure (the Yin) of the corresponding Organ that is affected.

Then, the palpation focuses on larger areas, each representing an Organ in a set called Hara (see photo). The pads of all the fingers, grouped together like a probe, palpate each area, ideally with equal pressure, to obtain information on the corresponding organ.

This technique can be juxtaposed with that of the palpation of the four quadrants, a method where the abdomen is divided into four anatomical zones, delimited by a horizontal line and a vertical line passing through the umbilicus. Each quadrant is probed to assess the possibility of an organ being damaged.

Palpation of the back

Each Viscera has its Shu point located on the first chain of the Meridian of the Bladder which runs through the back from top to bottom, irrigating the ganglion chain of the sympathetic system. The Shu points can be palpated one by one, or even in a continuous sequence using the “pinch-roll” (see photo), one of the techniques of the Tuina massage. Located on the posterior face (therefore Yang) of the body, they are related to the functioning of the Organs, rather than to their structure. For example, if a dull pain appears on palpation of the Kidney point (23V Shèn Shu), located at the level of the second lumbar vertebra, this is the index of a Kidney Yang Void. In the case of little Zachary’s asthma, palpation of the Shu point of the Lung Meridian (13V Fei Shu) was particularly painful, indicating chronic asthma.

Brand new points

The evolution of Chinese medicine since the beginning of the modern era has brought its share of new points among which we find among others diagnostic points. A painful sensation on palpation of the Dan Nang Xue point (located near the knee), for example, will confirm inflammation of the gallbladder. In addition, the pain caused by this condition will be relieved by puncturing the same point.