Palpation is an integral part of traditional Chinese medicine. We palpate to find various types of discomfort ... but how often do we palpate for comfort and pain relief? It's a natural complement to palpating for local discomfort.
To develop this skill requires patience, skilled communication and observation.
Locate Acupuncture Points That Relieve the Complaint
One may "test" candidate acupuncture points during the examination Example: shoulder pain. Press the acupuncture point and ask the patient if there is pain relief. If pressing St 38 (tiáo kÅu), the empirical point for shoulder pain) relieves the pain, then it is a viable point to consider for a point prescription.
Refine Point Function
Clarify the functions of acupuncture points. Example: shoulder pain. St 38 (tiÄo kÅu) is the empirical point for shoulder pain, but is not equally effective for the entire shoulder girdle. From experience, I can say it is most effective for the superior aspect of the shoulder between GB 21(jïan jïng ) and SJ 15 (tiÄn liáo) along the large-intestine channel. To see this yourself, press St 38 (tiÄo kÅu) and ask the patient to point to exactly where the pain relief is occurring, or exactly where the pain remains, with one finger.
Understanding the Qi Dynamic Comprehensively
Palpating the affected channel(s) surrounding the area of complaint may reveal areas of excess and/or deficiencies of the affected channel(s).
Example: right-side vertex headache along the gallbladder channel. The patient feels discomfort between GB 16 (mù chuÄng) and GB 17 (zhèng yÃng) which is aggravated upon pressing the local area and anterior to it. They feel comfort with pressing along the channel posterior to the affected area. This demonstrates a local and anterior excess of qi and a qi deficiency posterior to the affected area.
Further palpation reveals GB 17 (zhèng yÃng) relieves pain, but GB 16 (mù chuÄng) does not. In this example, GB 17 (zhèng yÃng) unblocks the stagnation so qi can flow from the excess areas to the deficient areas. This one needle treatment addresses the main complaint and restores qi balance in the area.
At the conclusion of treatment, both the pain and comfort along the affected channel should reduce so that the sensation of the area is similar to unaffected areas of the body.
Contributing Toward the Diagnosis
Palpating multiple points, each with a specific function, may confirm a diagnosis. Example: lower back pain. Possible diagnoses include local qi and blood stagnation and kidney qi deficiency. If palpation of Kid 3 (taì xï) relieves discomfort more than UB 40 (wÄi zhÅng), one may conclude that kidney qi deficiency is more dominant than a channel pathology.
Clarifying the intake
Palpating is important when the patient is unable to concisely articulate their complaint. Example: "anxiety" with chest discomfort, but unable to describe any additional details. If palpation of Lu 9 (tài yuÄnn) brings greater calm than Ht 7 (shén mén), and Lu 1 (zhhÅng fo) relieves chest discomfort more than Ren 14 (jù què), then grief is more dominant than lack of joy. Hence, one may consider lung patterns as the primary pathology and heart as secondary.
Example: lower back pain. Palpating the lumbar area of both ears relieves the entire lower back of the pain, but the point locations are slightly different from each other. Further questioning reveals that the location of each side of lower back pain is different from one another.
Palpation to Enhance Diagnosis & Treatment: A Few Caveats
Discomfort must be present at the time of examination. Make sure to ask the patient if their discomfort is present at the moment of examination. The patient may clearly and emphatically describe their pain ... from yesterday. They may have taken medication which relieved the discomfort prior to the examination.
The patient must assume an active role in treatment. Patients who prefer the passive, "fix me" role typically will not pay attention to discomfort changes or provide any useful information beyond, "It hurts here." This type of patient may even become annoyed with this type of clinical interaction.
The patient must be honest. The dishonest patient will give random answers, state that all points palpated will feel "good" or attempt to manipulate the clinician to get the points they want treated. Therefore, it is helpful to palpate points that will not yield pain relief to determine if the patient is truthful.
Patients have a limited attention span. Paying attention to discomfort and discomfort relief requires effort. Therefore, do not spend more than a few minutes palpating in the manner described above.
Patients with severe discomfort may have difficulty paying attention to palpation for relief. They are overwhelmed by their discomfort, and this prevents them from shifting their attention away from pain.
Closing Thoughts
Palpation for pain relief is a natural counterpart to palpating for pain. It is an effective addition to examination and treatment; as well as to help explore the subtleties of TCM theory.
However, it is not suitable for every patient. Therefore, I recommend developing this skill a few minutes at time with the best-candidate patients. Over time, you may notice greater control of the treatment, a deeper understanding of TCM theory, an intricate appreciation of the qi dynamic, and fast, positive clinical results.
Recommended Reading
- Howard L. "The Eleventh Question: ‘How You Doin'?'" Acupuncture Today, June 2012. https://www.acupuncturetoday.com/mpacms/at/article.php?id=32576
- Howard L. "The Mind of an Acupuncturist." Acupuncture.com, August 2009.
Lawrence Howard, LAc, MSAc is a New York State-licensed acupuncturist in practice since 1998, specializing in pain management. He is currently an acupuncture doctoral student at Pacific College of Health and Science.