Palpation diagnosis is an important component of the four diagnostic methods in Traditional Chinese Medicine (TCM), playing a crucial role in the process of syndrome differentiation. The application of palpation is broad, involving techniques such as touch, pressure, and tapping on various body parts including the head, neck, chest, abdomen, hands, feet, skin, and acupoints.1. Palpation of the Head and Face

Touching the head and face purposefully according to the condition helps to understand local and internal organ changes.

Palpation of the Head: In cases of head trauma, when pressing the area, it feels soft like a bag, accompanied by an increase in head circumference, with raised and hard edges, indicating a subcutaneous hematoma; if there are depressed symptoms, it often indicates a depressed fracture.

Palpation of the Forehead: Using the palm to press the forehead or lightly touching the forehead with four fingers helps to sense the body’s cold and heat conditions. A hot forehead indicates fever; a cool forehead indicates no fever.

Palpation of the Eyes: This is a common method in TCM for examining eye diseases, primarily used to detect the nature of the disease (deficiency or excess, cold or heat). Before palpating the eyes, the doctor should wash their hands and use gentle techniques. If there is eye pain that alleviates with pressure, it indicates deficiency; if the pain is severe upon pressure, it indicates excess. Severe eye pain, with the eyeball feeling hard as stone upon pressure, suggests conditions like glaucoma or acute conjunctivitis; if there is pus in the tear duct, pressing may release pus, indicating a leaking eye.

2. Palpation of the Neck

The neck is prone to nodules, lumps, and other conditions, or signs such as pulsation and muscle stiffness. Palpation of the neck mainly includes the following aspects:

Palpation of Goiter: If there are lumps on both sides of the throat, ask the patient to swallow; the lumps will move up and down with swallowing, indicating goiter. This is mainly caused by liver qi stagnation and phlegm accumulation, or by water and soil imbalance leading to phlegm and qi blockage. If there is only a lump that is hard and uneven, unable to move with swallowing, it is more likely to be a malignant condition, such as thyroid cancer.

Palpation of Nodules: On the sides of the neck or under the jaw, if there are multiple lumps, the larger ones are called scrofula, and the smaller ones are called nodules, often appearing like a string of beads. When pressed, the pain is not severe and may be accompanied by tidal fever and night sweats, indicating scrofula. This is often due to lung yin deficiency, with deficiency fire scorching fluids to form phlegm, accumulating on the sides of the neck. If there are one or two painful lumps on the sides of the neck, with increased pain upon pressure and accompanied by fever, it is often due to pathogenic heat stagnation leading to blood stasis.

Diagnosis of Tracheal Displacement: In a normal person, the trachea is located in the center of the neck. The patient should sit comfortably or lie down, with the head positioned straight. The doctor places the index and ring fingers on both sides of the sternoclavicular joint, and the middle finger on the trachea, ensuring the distances from the index and ring fingers are equal. This can help determine if the trachea is displaced. Tracheal displacement is often caused by compression or traction. Conditions like pleural effusion, lung cavities, or lung tumors can pull the trachea towards the affected side.

3. Palpation of the Chest and Flanks

For chest and flank palpation, the patient should sit upright or lie down. The doctor uses touch, palpation, and tapping techniques, with tapping being the most commonly used. When using tapping, the doctor slides the middle finger of the left hand down along the intercostal spaces (parallel to the ribs) and taps the distal joint of the left hand’s middle finger with the right hand’s middle finger with moderate force. During chest examination, first palpate the front chest, then the side and back, paying attention to the comparison between symmetrical areas on both sides of the chest.

During percussion, the sound from the chest is usually clear. Individual differences and varying locations can change the clarity of the sound. In obese individuals, those with developed pectoral muscles, or those with full breasts, the percussion sound may be slightly duller, with the back sounding duller than the front. It is also important to note the boundary between clear and dull sounds; during percussion from top to bottom, the boundary between dull and solid sounds indicates the lower lung border. Under normal breathing, the lower lung border is typically located at the 5th intercostal space along the right clavicular line, the 7th intercostal space along the midaxillary line, and the 10th intercostal space along the scapular line.

Lowering of the lower lung border can indicate conditions like lung distension or abdominal organ prolapse; raising of the lower lung border can indicate conditions like lung atrophy, abdominal distension, or intra-abdominal tumors. A prominent anterior chest with a clear drum sound upon percussion is mainly due to lung qi stagnation, commonly seen in lung distension and pneumothorax; if the percussion sound is dull or solid and accompanied by chest pain, it is often due to lung tumors or lung abscesses; if there is local cyanosis and swelling, it is often due to trauma.

The area below the 5th rib on the right side of the chest is the liver area. The doctor places the palm of the left hand firmly on the skin of the liver area and taps the back of the left hand with a fist from the right hand with moderate force. If the patient experiences pain in the liver area, it often indicates pathological changes in the liver or gallbladder, such as subphrenic abscess.

4. Palpation of the Breasts

This is a common method for examining breast diseases in surgery. When palpating the breasts, first divide the breast into quadrants using the nipple as the center, drawing horizontal and vertical lines to create four areas. With fingers together, place the pads of the fingers flat on the surface of the breast, sequentially pressing on the outer upper, outer lower, inner lower, inner upper areas, and finally towards the center nipple and areola. When massaging the breast, start with the healthy side, then examine the affected side. The left side is examined in a clockwise direction, while the right side is examined in a counterclockwise direction. Also, check for any discharge from the nipple.After the examination, palpate the armpit to check for nodules or lumps. When palpating the breast, avoid pinching the breast tissue with fingers, as this may misinterpret the pinched glandular tissue as a lump. The outer upper area of the breast is prone to breast cancer, so it should be palpated carefully; if there is accessory breast tissue, it should also be examined for lumps.

Significant lumps that appear before menstruation, accompanied by pain, returning to normal after menstruation, indicate mammary dysplasia, closely related to the menstrual cycle. Gentle pressure on the breast may cause pain, and redness with a burning sensation, with rapid enlargement of lumps, often indicates breast abscess; hard lumps that are round or oval, the size of an egg, with clear boundaries, connected to the skin, and without significant pain, may develop slowly and eventually rupture, releasing thin pus mixed with curd-like material, often indicating breast tuberculosis; irregularly shaped, hard lumps with unclear boundaries, uneven surfaces, and palpable lumps in the armpit may suggest breast cancer. In men or children, flat or round lumps around or below the areola, slightly hard and painful upon touch, are often due to breast dysplasia, common in males and children.

Early diagnosis of breast diseases is crucial. Women should develop a habit of self-examining their breasts: look, touch, and squeeze. Looking involves observing whether the shape of both breasts changes with arms down or raised; touching involves standing, sitting, or lying down to feel for nodules or lumps, and checking for swollen lymph nodes in the armpit; squeezing involves gently pressing the nipple to see if any fluid or bloody fluid is discharged. Through self-examination, breast diseases can be prevented.

5. Palpation of the Abdomen

Palpation of the abdomen involves pressing and tapping the epigastric area and the entire abdomen. The xiphoid process is the epigastric area, and the area around the navel is the abdominal area, including the left upper abdomen, right upper abdomen; below the abdominal area is the lower abdomen; the sides of the lower abdomen are the lesser abdomen. During abdominal palpation, the patient is often in a supine or lateral position, exposing the epigastric area, with legs together, flexed at the hips and knees to prevent local muscle tension. The doctor stands on the patient’s right side, using the second, third, fourth, and fifth fingers of the right hand together to press and feel for fullness, tenderness, lumps, softness, and hardness in the abdomen, which serves as diagnostic evidence for the location and nature of the disease.

Diagnosis of Tenderness: By touching and pressing the abdomen, check for lumps or tenderness. Abdominal pain that feels better with pressure and has a soft abdominal wall often indicates a deficiency condition; abdominal pain that worsens with pressure and has a hard, full abdomen often indicates an excess condition. Tenderness in the abdomen indicates that the corresponding abdominal organ has undergone pathological changes: if there are lumps or tenderness under both ribs, especially with rib tenderness, it often indicates liver, gallbladder, or right kidney issues; left rib tenderness often indicates spleen or left kidney issues; tenderness or lumps below the xiphoid process often indicates gastric issues; tenderness around the navel often indicates small intestine or spleen issues; tenderness in the lower abdomen often indicates bladder issues or female reproductive organ issues; tenderness in the lesser abdomen often indicates large intestine or appendicitis issues.

Diagnosis of Cold and Heat: Through abdominal palpation, one can understand whether the abdomen prefers cold or heat. If the abdomen prefers heat, it is often a cold condition; if the abdomen prefers cold, it is often a heat condition; if there is burning heat in the chest and abdomen with cold extremities, it often indicates true heat with false cold.

Diagnosis of Softness and Hardness: In normal individuals, the abdomen feels soft, with appropriate tension, without distension or tightness. If the abdomen feels relaxed and soft upon pressure, it often indicates a deficiency condition; if the abdomen feels tight and hard upon pressure, it often indicates an excess condition. If the entire abdomen feels soft and weak, with decreased tension, it often indicates depletion of essence and qi, commonly seen in chronic or severe illness or in postpartum women, and may also occur in frail elderly individuals; if the entire abdomen has no resistance and tension is completely absent, it often indicates atrophy or paralysis; if the lower right abdomen is tense, it often indicates intestinal abscess; if the upper right abdomen is tense, it may indicate gallstones or gallbladder distension.

Diagnosis of Distension: If the patient feels abdominal distension, and upon pressure, the abdomen feels full, elastic, and tender, it often indicates an excess condition; if the epigastric area feels distended but soft and lacking elasticity upon pressure, and without tenderness, it often indicates a deficiency condition.

Diagnosis of Masses: During palpation, if there are masses in the epigastric area, attention should be paid to the location, shape, size, hardness, tenderness, and mobility of the masses. If a mass does not move upon pressure and has a fixed painful area, it is often a pathological accumulation; if a mass moves upon pressure or has no fixed painful area, it is often a dispersive accumulation. Larger masses indicate deeper pathology; irregularly shaped and rough-surfaced masses indicate more severe pathology; masses that are hard as stone indicate a malignant condition.

Diagnosis of Worm Accumulation: If there are lumps in the abdomen that appear to move upon pressure, or if they feel like strings that shift in various directions, or if there is a sensation of worm-like movement upon pressure, it often indicates worm accumulation.

6. Palpation of Acupoints

Acupoints are key areas where qi and blood of the meridians gather, are infused, or pass through, and are also the points where the qi of the five zang organs and six fu organs is transmitted, reflecting internal organ changes on the body surface. Therefore, pressing specific acupoints can help determine certain internal organ diseases. When palpating acupoints, the patient should be seated or lying down, and the doctor uses one or both index fingers or thumbs to press the acupoints, noting whether there is tenderness, nodules, cord-like structures, or other sensitive reactions. If any abnormalities occur, the changes and reactions at the acupoints can help identify which internal organ is affected. If there is significant tenderness at the Zhongfu (中府) acupoint, it often indicates lung disease; tenderness at the epigastric (胃俞), Zusanli (足三里), or Stomach (胃脘) acupoints often indicates gastric disease; tenderness at the Liver Shu (肝俞), Qimen (期门) acupoints often indicates liver disease; tenderness at the Zhangmen (章门) acupoint often indicates spleen disease, etc.

Common acupoints used in clinical diagnosis of organ diseases include:

Heart Disease: Daling (大陵), Jueque (巨阙), Shanzhong (膻中).

Liver Disease: Qimen (期门), Taichong (太冲), Gan Shu (肝俞).

Spleen Disease: Zhangmen (章门), Pi Shu (脾俞), Taibai (太白).

Lung Disease: Fei Shu (肺俞), Taiyuan (太渊), Zhongfu (中府).

Kidney Disease: Taixi (太溪), Qihai (气海).Gallbladder Disease: Riyue (日月), Dan Shu (胆俞).

Stomach Disease: Zusanli (足三里), Wei Shu (胃俞), Wei Pan (胃脘).Small Intestine Disease: Guanyuan (关元).

Large Intestine Disease: Tianshu (天枢), Da Chang Shu (大肠俞).

Bladder Disease: Zhongji (中极).

From this, it is clear that determining the location of diseases based on acupoint positions and meridian pathways has significant reference value for clinical treatment.

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