Palpation

Question 1

When palpating the abdomen, what would the following findings indicate?
1. Hardness/worse with pressure
2. softness/relieved with pressure
3. lower abdomen soft & flabby
4. Abdo masses that come & go and move with palpation
5. Fixed abdo masses

Answer 1

1. full condition
2. empty condition
3. Yuan Qi Xu
4. Qi stagnation
5. Blood statgnation

Question 2

What does the epigastric region represent diagnostically and what would abnormalities here indicate?

Answer 2

• heart, stomach, spleen
  Hardness just below the Xiphoid process
  -> Heart Qi & Blood stagnation (can be due to emotional problems)
  Hardness/distension
  -> stomach qi/blood stagnation
  Softness to touch but subjective fullness
  -> Spleen Qi Xu

Question 2

What does the hypochondrium region represent diagnostically and what would abnormalities here indicate?

Answer 2

Liver and gallbladder
Tenderness
-> Liver Qi stagnation, blood stagnation, damp-heat in
Feels better with pressure
-> Liver Blood Xu

Question 3

What does the umbilical region represent diagnostically and what would abnormalities here indicate?

Answer 3

Kidney, Chongmai & Governing Vessel
Hardness, fullness or pain
-> Qi/blood stagnation of the chongmai
Softness
-> Kidney/chongmai/GV Xu

Question 4

What does the hypogastric region represent diagnostically and what would abnormalities here indicate?

hardness and pain

Answer 4

Small intestine, kidney, bladder, uterus, liver
Hardness
-> dampness in Taiyang channel
Pain
-> Qi/blood stagnation of the taiyang channel

Question 5

What does the iliac region represent diagnostically and what would abnormalities here indicate?

Answer 5

Intestines and Chongmai
Hardness
-> dampness in intestines, blood stasis in chongmai
Pain
-> blood stasis in chongmai
Mass formation
-> blood stasis in chongmai or intestines

Question 6

What does coldness on various parts of the body indicate?

Answer 6

4 limbs - Spleen & Stomach Yang Xu
Loins, lower back, feet - Kidney-Yang Xu
Lower Abdomen cold - Spleen-yang Xu

Question 7

What does warm/hot skin indicate?
skin-hot
hot at first - but ceases to feel hot with pressure
hot over blood vessel on medium pressure but not heavy pressure
feels hot on heavy pressure reaching almost to bone

Answer 7

skin-hot: damp heat
skin hot first to touch, but if pressure of fingers is maintained it ceases to feel hot: invasion of exterior wind-heat with the pathogenic factor still only on exterior
Skin over a blood vessel hot on medium pressure but not on heavy pressure: interior heat in the middle burner/heart
skin feels hot on heavy pressure, which nearly reaches the bone:
empty-heat from yin Xu

Question 8

What are common causes of cold hands, feet, fingers and toes?

Cold hands & feet
Cold hands
Cold feet
Cold fingers & toes

Answer 8

Cold hands and feet - spleen/stomach yang Xu (Blood Xu in women)
Cold hands - lung and/or heart-yang Xu (Heart-blood Xu in women)
Cold feet - kidney-yang Xu (liver-blood Xu in women)
Cold fingers and toes - Liver-qi stagnation

(Less common - cold hands and feet due to phlegm/interior heat obstructing circulation of Qi)

Question 9

What are the Front Mu points?

Answer 9

Lung - LU 1
Large Intestine - ST 25
Stomach - CV 12
Spleen - LV 13
Heart - CV 14
Small Intestine - CV 4
Bladder - CV 3
Kidney - GB 25
Pericardium - CV 17
Sanjiao - CV 5
Gallbladder - GB 24
Liver - LR 14

Question 10

What does different findings at the front mu points indicate?

Hard vs soft (hollow)
Hot vs cold
Superficial vs deep
Nodules
Veins
Pain
Oedema
Hollowness

Answer 10

Hard vs soft (hollow) - excess/Xu
Hot vs cold - heat/yin Xu & Cold/yang Xu
Superficial vs deep - Acute/chronic
Nodules - Phlegm / blood stagnation
Veins - blood stagnation / spleen Qi Xu
Pain - Qi stagnation
Oedema - Fluid accumulation / Yang Xu
Hollowness - Areas of Xu

Question 11

What are the main therapeutic effects of the front mu points?
LU 1, ST 25, CV 12, LV 13, CV 14, CV 4, CV 3, GB 25, CV 17, CV 5, GB 24, LR 14

Answer 11

LU1 - used in acute Excess patterns of the Lungs, to clears Lung-Heat
ST25 - used to regulate the intestines and stop diarrhoea & pain
CV12 - widely used to tonify Stomach Qi/Yin and spleen-Qi to resolve Phlegm & Dampness
LV 13 - used to move Liver-Qi when it stagnates in the epigastrium or lower abdomen causing spleen deficiency. Harmonises Liver and Spleen
CV 14 - used in heart patterns with anxiety to calm the mind
CV 4 - used to regulate the Small intestine. However mostly used such as tonifying the Kidneys & original Qi
CV 3 - used in acute Excess patterns of bladder, such as damp-heat
GB 25 - used in acute Excess patterns of the bladder, to clear heat & dampness
CV17 - used to tonify and/or move Qi in the chest
CV5 - used in Excess patterns of the Lower burner, such as damp-heat accumulating in the lower jiao
GB24 - used to clear GB damp-heat in acute excess patterns of Liver and GB
LR14 - used to move Liver-qi when it stagnates in the epigastrium/lower jiao causing spleen Xu - it harmonises liver and spleen

Question 12

What does the pulse reveal?

Answer 12

State of zangfu, qi and blood
Person’s constitution
State/location of disease/pathogen
Whether the treatment is appropriate/successful

Question 13

How does a normal pulse feel?

Answer 13

Stomach-qi is present - relatively soft, calm & gentle
spirit present - regular and soft
Root - should be felt on deep level and in 3rd position

Question 14

What is the indication of rapid vs slow pulse?

Answer 14

Rapid
-> 5-6 to one cycle of physicians breathe
-> heat pattern
Slow
-> less than 4 beats to one breathe
-> cold pattern

Question 15

What is the quality and indication of floating vs sunken (deep) pulse?

Answer 15

Floating
Superficially located felt by light touch and grows faint with increased pressure
-> external pathogen or yin xu
Sunken (deep)
Can only be felt when hard pressure is applied
-> internal pattern

Question 16

What is the quality and indication of replete (forceful) vs vacuous (mindless, lack of meaning) pulse?

Answer 16

Replete
Felt forcefully in all positions cun, guan & chi
-> excess pattern
Vacuous
Feeble, soft & void when pressure is applied
-> Qi Xu

Question 17

What is the quality and indication of long vs short pulse?

Answer 17

Long
Extends beyond the normal range of cun, guan & chi
-> heat pattern
Short
Shorter than the normal 3 positions
-> serious Qi Xu, stomach Qi Xu

Question 18

What is the quality and indication of fine (thin/thready) pulse?

Answer 18

Thin as silk thread, straight & soft, feeble yet always perceptible upon hard pressure
Indicates blood Xu

Question 19

What is the definition and indication of slippery pulse?

Answer 19

comes & goes smoothly like beads rolling on a plate, smooth, rounded, oily, slides under fingers
Indicates dampness/phlegm/food retention/pregnancy

Question 20

What is the definition and indication of rough/choppy pulse?

Answer 20

Doesn’t come & go smoothly, with small, fine, slow joggling tempo like scrapping bamboo with a knife. Feels rough under fingers like a ragged edge
Indication - Blood Xu/stagnation, Jinye Xu

Question 21

What is the definition and indication of tight pulse?

Answer 21

Feels like a twisted & stretched cord/rope
indicates Cold pathogen/pain

Question 22

What is the definition and indication of wiry/string-like pulse?

Answer 22

Straight, long and taut like a musical string. Thinner, harder & tauter than a tight pulse, feels sharp
indicates Liver disharmony - eg Liver qi stagnation

Question 23

What is the definition and indication of surging/flooding pulse?

Answer 23

beats like dashing waves with forceful rising & gradual decline. It’s big, long & superficial.
Indicates excess heat

Question 24

What is the definition and indication of soggy pulse?

Answer 24

soft, thin & floating pulse that grows faint with increasing pressure indicates dampness, qi/yin Xu

Question 25

What is the definition and indication of dissipated/scattered pulse?

Answer 25

Feels diffused & feeble on light touch, growing faint upon hard pressure. It feels as if 'broken' into small dots lacking coherent, unified & robust form. Indicates Severe Xu of Qi/blood/jing. Serious condition

Question 26

What is the definition and indication of Hollow pulse?

Answer 26

floating, large, soft & hollow. Palpable on superficial level & deep, but empty on middle. Indicates Blood loss

Question 27

What do the 3 depths of pulse reflect?

Answer 27

Superficial - state of qi (and yang organs), exterior diseases ( plus heart & lungs) Middle - state of blood, stomach & spleen diseases Deep - state of yin and yin organs, interior diseases (plus liver and kidneys)

Question 28

Your patient complains of pain in the area of his rib cage, a recent loss of appetite, and an increase in sense of overwhelm with work and personal stress. When palpating his abdomen, you note that there is tenderness around the hypochondriac region. Pulse is wiry and weak. What is the most appropriate diagnosis for this patient? What is the treatment principle for this case? Discuss why the following points might be indicated: CV12, LR14, LR3, SP3

Answer 28

Rib cage/hypochondriac pain - Indicates Liver Qi stagnation Feeling of overwhelm, stress - Affects Liver function (Liver Qi constraint) Loss of appetite - Spleen Qi weakened or impaired by Liver overacting Tenderness in hypochondriac region - Confirms local Qi stagnation of the Liver Pulse: wiry and weak - Wiry → Liver Qi stagnation - weak → underlying Spleen Qi deficiency Therefore: Liver invading the Spleen (Liver-Spleen disharmony) Soothe the Liver, regulate Qi, strengthen the Spleen, and harmonise the Liver–Spleen relationship CV12 - Front-Mu point of the Stomach; regulates Stomach Qi, tonifies Spleen and Stomach - Supports digestion, relieves epigastric fullness, and counteracts Spleen Qi impairment caused by Liver Qi stagnation LR14 - Front-Mu point of the Liver; meeting point of Liver and Spleen channels - Moves Liver Qi, alleviates hypochondriac pain, harmonises Liver and Spleen — directly addresses the root disharmony LR3 - Yuan-Source point of the Liver; moves Liver Qi and pacifies the mind - Relieves Qi stagnation from emotional stress, smooths Liver Qi flow to prevent further attack on the Spleen SP3 - Yuan-Source point of the Spleen; tonifies Spleen Qi, resolves Dampness - Strengthens Spleen to support digestion and counteract the Liver’s overactivity

Question 29

Your 25-year-old patient tells you about she has been experiencing amenorrhea for 3 months. Prior to this, her menstruations were painful with large blood clots. They usually lasted for 3 days, and the colour varied from dark red to brown. When palpating her abdomen, you notice that the central and lateral lower regions feel full and there is a solid 1cm mass present. The mass is tender with pressure. What is the most appropriate diagnosis for this patient? What is the treatment principle for this case? Discuss why the following points might be indicated: SP6, SP10, LR5, LR8

Answer 29

Amenorrhea - Obstruction of Blood flow in the uterus (stasis or deficiency) Dysmenorrhea with clots - Blood stasis; clots indicate static, dark blood Short duration & dark color - Stagnant blood failing to flow smoothly, may be partially congealed Abdominal mass (1 cm), tender - Localized Blood stasis, possibly in the uterus or lower abdomen (e.g., fibroid or blood stasis nodule) Lower abdominal fullness - Qi stagnation contributing to stasis History of painful menstruation - Previous Liver Qi stagnation causing blood stasis Blood stasis in the uterus (Chong & Ren channels), often due to Liver Qi stagnation transforming into Heat → Blood stasis Invigorate Blood, remove Blood stasis, regulate Liver and Chong/Ren SP6 (Sanyinjiao) - Meeting point of Spleen, Liver, Kidney channels; tonifies blood, regulates menstruation - Strengthens Spleen to produce blood, moves Liver Qi, harmonizes Blood SP10 (Xuehai) - “Sea of Blood”; invigorates Blood, dispels stasis - Directly treats Blood stasis and menstrual irregularities LR5 (Ligou) - Luo-Connecting point of Liver; moves Liver Qi - Relieves Liver Qi stagnation causing blood stasis; helps reduce tension in lower abdomen LR8 (Ququan) - He-Sea point of Liver; nourishes blood - Tonifies Liver blood to support menstruation and prevent further stagnation; strengthens the root of reproductive function

Question 30

Your patient tells you that she has been experiencing weight gain with oedema recently. Her appetite has also slightly reduced, she is lethargic, and her limbs feel weak. When palpating her abdomen, you notice tightness in the epigastric region but overall her abdomen feels flimsy and cold. Her pulses are slippery and slow. What are the possible diagnosis for this patient? What other palpation can be performed? What is the treatment principle for this case? Discuss why the following points/interventions may be indicated: SP3, ST36 Moxa, KD5, CV4 moxa, CV6 moxa

Answer 30

Spleen Yang Deficiency with Damp Accumulation Weight gain, oedema - Retention of fluids due to Spleen Yang deficiency; Spleen fails to transform & transport fluids Reduced appetite, lethargy, weak limbs - Typical Spleen Qi deficiency signs Flimsy and cold abdomen - Spleen Yang deficiency (cold, weak digestive function) Epigastric tightness - Mild stagnation or accumulation of dampness Slippery pulse - Damp accumulation Slow pulse - Cold or Yang deficiency Check for localized oedema: lower limbs, ankle region, or around the umbilicus Check for pitting vs non-pitting oedema (to differentiate type of fluid retention) Assess for kidney region warmth and tenderness (lower back/loins) Check for abdominal distension or fullness in LU/Spleen area (confirm damp accumulation) Warm and tonify Spleen Yang, promote fluid metabolism, resolve damp, support Kidney Yang if needed SP3 (Taibai) - Yuan-Source of Spleen, tonifies Spleen Qi and Yang - Strengthens Spleen function to transform fluids ST36 + Moxa - Tonifies Spleen/Stomach Qi and Yang - Promotes digestion, strengthens post-natal Qi, resolves damp; moxibustion adds warming Yang effect KD5 (Shimen) - Xi-Cleft point of Kidney, regulates Chong channel - Supports Kidney function in water metabolism and addresses fluid retention CV4 + Moxa - Tonifies Kidney and Spleen Yang, warms lower abdomen - Strengthens source Yang, improves fluid transformation CV6 (Qihai) + Moxa - Tonifies Qi and Yang, warms lower abdomen - Strengthens original Yang, improves overall energy and fluid metabolism