The ATt of Palpatory Diagnosis In Oriental Medicine SKYA GARDNER-ABBATE Tiremuntly MARK 1. SEEM(CHURCHILL LIVINGSTONE ‘An imprint of Harcourt Publishers Limited © Harcourt Publishers Limited 2001 @)is a registered trademark of Harcourt Publishers Limited ‘The right of Skya Gardner-Abbate to be identified as author ofthis ‘work has been asserted by her in accordance with the Copyright, Designs and Patents Act 1988 All rights reserved. No part ofthis publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any ‘means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers (Harcourt Publishers Limited, Robert Stevenson House, 1-3 Baxter's Place, Leith Walk, Edinburgh EH 3AP), ora licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, ‘99 Tottenham Court Road, London WIP OLP. First published 2001 Reprinted 2001 ISBN 0 443 07058 X British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. Library of Congress Cataloging in Publication Data ‘A catalog record for this book is available from the Library of Congress. Note Medical knowledge is constantly changing, As new information becomes available, changes in treatment, procedures, equipment and the use of drugs become necessary. The author and the publishers have taken care to ensure that the information given in this text is accurate and up to date. However, readers are strongly advised to confirm that the information, especially with regard to drug usage, complies with latest legislation and standards of practic. tte pists polgysbse par ‘rom sutra oes Printed in China |To my parents, who taught me that love is touch Skya Gardner-Abbate began her career as a medical sociologist serving as a Peace Corps volunteer in Brazil, then later taught in the Sociology Department of the University of Rhode Island (1978-81). In 1963 she graduated from the acupuncture program ot the Institute of Traditional Medicine (Santa Fe, New Mexico) and has since undertaken two advanced clinical training programs with the Academy of Traditional Chinese Medicine in Beijing, China (1988 and 1989). Skya is a licenced Doctor of Oriental Medicine in the state of New Mexico, Executive Director of Southwest Acupuncture College (with three campuses in Santa Fe and Albuquerque, New Mexico, and Boulder, Colorado), where she teaches needle technique, diagnosis and Japanese acupuncture systems, and former President of the New Mexico Association of Acupuncture and Oriental Medicine. She also has a private practice integrating classical Chinese diagnosis with her subspecialty in Japanese diagnosis. She has served over 6 years as an educational expert and Commissioner for the Accreditation Commission for Acupuncture and Oriental Medicine, the national ‘organization which accredits professional degree programs in Oriental medicine Skya is the author of Beijing: the new forbidden city (1991) and Holding the tigers tail:an acupuncture techniques manual in the treatment of disease (1996) and is 2 regular contributor to the American Journal of Acupuncture, For Churchill Livingstone: Publishing Manager: Inta Ozols Project Manager: Jane Dingwall Design Direction: George AjayiForeword The Art of Palpatory Diagnosis in Oriental Medicine by Skya Gardner-Abbate shows how the infusion of Japanese acupuncture into North America over the past two decades is beginning to reshape how this wonderful medicine might be practiced ~ as an art of palpation. In this comprehensive text, the author presents palpation not just as assessment and diagnosis, not just as treatment, but as an avenue through which client and practitioner might share something pro- found of the experience of illness that unites them. Skya Gardner-Abbate bases her exploration of palpation in acupuncture not only on a poetic feel for Japanese-style treatment as a palpatory practice, but also on her hands-on feel derived from a decade and a haif of practice and teaching aimed at integrating Japanese acupuncture into Chinese acupuncture and Traditional Chinese Medicine approaches. In this ambitious textbook, the author provides English-speaking practitioners of acupuncture, Oriental bodywork and physical medicine with a step approach for coming to grips with s of Japanese acupuncture in such a way as to integrate them into their own practices. These basics begin with an evaluation of the abdomen as a starting point for treatment and the author moves from a review of the key abdominal maps to her own simplified approach to abdominal evaluation. From this beginning in the root, she moves to the palpation and release of key areas of the body as stressed by the renowned Kiiko Matsumoto, namely the sinuses, the neck and SCM, the navel, the rectus abdo- minis and scars. She covers key points in Japanese acupuncture for clearing these areas, Japanese needle techniques and the role of the Eight Curious Vessels in this style of treatment according to various Japanese practitioners. Whether readers use this text as an introduc- tory glimpse at the role of palpation in Japanese acupuncture or as a course in the basics of this approach, they are sure to come away with a more vibrant, dynamic feel for what lies beneath the acupuncture meridians and points and how this might all be accessed through informed touch. New York 2000 Mark D SeemSECTION 4 Forms SECTION CONTENTS Form 1 Abdominal diagnosis: the healthy Hara examination 237 Form 2 The modified abdominal exam 239 Form 3. Navel diagnosis form 240 Form 4 Thigh clearance form 241 Form 5 Scar treatment form 242 Form 6 Sinus evaluation form 243 Form 7 Neck evaluation form 244 Form 8 Tonsillar treatment form 245 Form 9 How to perform back evaluations and treatment 246FORM 1 Patient's name: Major complaint: Date: _ ABDOMINAL DIAGNOSIS: THE HEALTHY HARA EXAMINATION Check (¢) in the Normal column if the patient has this healthy characteristic, check (7) in the Abnormal column ifthe finding is abnormal. | Characteristics (The Healthy Hara) Significance/Comments Koop hands there a short amount of time | Normal | Abnormal Diagnosis Ftemperatr a) fairly uniform ‘As warm-blooded mammals, the human body is more Yang than Yin. b) cooler above umbilicus Why should there be a cool Stomach and not a warm Stomach? Warmth consumes ‘Yin which leads to ST Yin Xu and Heat which leads to KI Yin Xu. ) warmer in the lower right quadrant (LAQ), the Mingmen LRQ = Yin, Yin, Yin. Needs Mingmen Fire to balance it, Therefore should feel warm. area 2. Moisture: Not dried up, withered, scaly or fatty a) slightly moist, deposits. 3, Resilient: a perpendicular assessment. Check: CV 12, ST 251, ST 25R, CV 6, CV 4 ) bouncy, elastic, not hard or mushy (it abnormal note quality found in ‘Abnormal column.) 1. Hard, Excess, replete, aggravated by pressure = tense, unhealthy tissue 2, Mushy = Deficiency, vacant, soft or full but not aggravated by pressure; pain may be relieved, 3, Hardness on top often has Deficiency below or the reverse. Patient says doesn't eel anything. ove ST 25L, ST 25R ove ova 4, Strength: a surface assessment done at CV 12 and ST 25L a) looser above umbilicus especially at CV 12 1. Substernal tension is the cause of many problems; seen in TCM as KI Yin Xu (because tight = ST Yin Xu). ST Yin Xu leads to KI Yin Xu. Mental degeneration begins with a tight stomach, b) stronger on left side ST 25 (Tianshu) (if abnormal, comment on quality found.) 2. Strong ST 25 (Tianshu) = sufficient Blood. 5. Shape: a) even, symmetrical, including umbilicus, rib cage and size of the sternocostal angle (SCA). Not sunken, fat, thin, putty, etc. (See Fig. 6.18) 1. Sunken, thin = Deficiency 2. Putty fat = Yang Deficiency 8. Narrow SCA = ST Yin Xu ~ KI Yin Xu 6. Pulsation at CV 6: a) palpable in the middle to deep position ‘Upon palpation should feel pulse at CV 6 (Ginal) = energy of the Kidneys communicating with each other. More important than radial pulse, 237238 FORMS 7. Depression along Ren channel and slight depression at CV 12 and above umbilicus Ren Channel, primordial channel, formed after the first cell division from 1 to 2 cells. Structural meridian, Controls all the Yin ‘meridians. Good constitution, good genetic inheritance. 8. Breathing: a) noticeable rise and fall of abdomen below umbilicus To bring LU Gi to Ki area. The Kidney grasps the Gi 9. Point inspection (for pathology) T ‘Soe Table 6.2 10. Other (specify) General diagnosis: ‘Treatment plan:FORMS 239 FORM 2 THE MODIFIED ABDOMINAL EXAM Patient's name: Major complaint and accompanying symptoms: __ Palpate these points Palpation Signs of point Clinical Clearance sensation, degree pathology significance of points used of tenderness or point pathology | and degree of vacancy ‘or palpation clearance sensation obtained | CV 15/14 (iuwei/Juque) CV 12 (Zhongwan) | | ‘ST 25 (Tianshu) Left | and Right CV 6 (Qihai) CV 4 (Guanyuan) General abdominal map: circle points which were tender: [Result Gl clowrance: Blsesseseessuu use uensnes sue uusseennneeysEeE)240 FORMS FORM 3 NAVEL DIAGNOSIS FORM Patient's name: _ Date: Major complaint and accompanying symptoms: aa Record the results of observation and palpation of the navel in the appropriate column Healthy navel description a Healthy Unhealthy | 1. The navel is well shaped with strong surrounding tissue, a slight depression above it. No interruptions, indentations. Not ‘looking up or down’ 2. It has a firm navel border 3. There is no puffiness around it 4, There is a full pulsation around it 5 itis tucked in 6. It is not too wide 7. Itis not too tiny, too narrow, too deep or too long (specify) 8. Itis not smal, flat or shallow 9. Itis centrally located on abdomen 10. itis loose above and resilient below 11. The area surrounding the navel is not hard 112. The area surrounding the navel is without pain or reactivity 13. There is a slight depression above navel in the area around CV 9 (Shuifen) and no tendemess upon palpat Other: = Drawing: Tenderness ~ where? Describe: Ability to clear navel. What points had the most clearance value’ Treatment with what modalities: Effect on major complaint if any and/or reaction to treatment:FORMS 241 FORM 4 THIGH CLEARANCE FORM Patient's name: Date: ‘Major complaint and accompanying Symptoms; 1. After abdominal clearing, what was the most significant pathology remaining that you were unable to obtain sufficient clearance on?. 2. Circle the leg, meridian and point which was the most tender. Right SP 1234 LR 1234 Ki1234 Left $P1234 LR 1234 Kl1234 3, Record points used to clear the most painful thigh points. [Points | Degree it contributed to clearance Ku LA4 ‘SP 6 KI6 KIS KI7, 4, Describe the patient's reaction to thigh palpation, what you felt if anything upon palpation, presentation of patient's thighs. Then record the results of the thigh clearance/patient's reaction to thigh clearance. 5. After the thigh clearance go back and check the points on the abdomen on which you did not obtain 100% clearance, Was there any change in abdominal presentation? Describe.242 FORMS FORM5 SCAR TREATMENT FORM Patient's name: Date: ‘Major complaint and accompanying symptoms: ‘The Scar - Inspection 1, Description (shape, size, color, texture, height, or any other sensations associated with it): 2. Location: Palpation 3. Sensation upon palpation: ‘Treatment 4, Treatment (which modalities used and why): 5. Result of treatment of scar (changes in color, size, shape, texture, height, accompanying sensations, other): 6. Effect on major complaint if any: 7. Other comments:FORMS 243 FORM 6 SINUS EVALUATION FORM Patient's name: _ _— Date: Major complaint and accompanying symptoms: Check off any of the signs and symptoms the patient may have under the appropriate column, ‘Signs/symptoms Etiology and diagnosis Needle techniques: Observations | Abnormal | Normal 1. Sinus problems or | Weak Lung function, broken | Consult specific manifestation history of same. nose, birth trauma, ote. described below and treat L 2, Deviated septum | 1. Same as 1 plus lack of | Palpate between nose and facial ‘ee flow of Qi and Blood in} bones; needle at 45° angle | the local area leads to transversely towards the insufficient oxygenation. lateral aspect ofthe face or 2. Local infection apply Tiger Thermie to the area, birth, broken Retain 10-20 minutes. [3 Floating faciat 1. Focal infection, Heat in the | Needle transversely towards | capillaries (engorgement | Blood or Heat and Blood lateral aspect of face or bload of nasal Blood vessels) | Stasis. Can be due to inverted | locally. Relieves hemostasis, ‘on orbital ridge of nose | postures, hot water, LR Heat, | invigorates Qi and Blood. Can cor below eye and/or —_| coffee, alcohol, weather, add LI 4 and LU 7 for facial uty cheok ———_| pollution. edema I “4, Tenderness in sinus | Preclinical or cinical sinus | Needle perpendicularly or areas (ST 2, GB1, problems transversely toward the lateral ‘Yuyao, BL 2) ‘aspect or apply Tiger Thermie moxa around the orbital area for about 3 minutos ‘5. Red coloration in the | 1. Pituitary gland reflex can | Needle or bleed or intradermal ¢labela (Yintang) lead to thyroid problems, Yintang. Can add SI 3 | region ineomnia, infertility or | memory problems 2. Heat in Blood, HT or SP 3. Serious, chronic sinus infection in cavity 6 Tight Particularly posterior SOM = | See neck protocols sternocleidomastold | weak immunity or autonomic | STR, uso KI6; ST SL, use KI 7 muscle nervous system problems then TE 5R, GB 41L for both | Needle ST for 1 min, Massage works usta wall | 4. To treat muscie a8 a whol Kio, KI7, 7E5, 6B 41 2, TE 16 Check tum head a. ST 25R may clear neck Why? Neck could pathogen and ST 25R treats LU and immunity ». Naganos 3. ST9-TE rlases carotid compression 7. Pathology atthe KI | 7, Kidney disorders, Font | Seo navel protocol in 16areaorSt 25R) | Mucf the Kidney (according | Chaptor 10 to Dr Manaka)~ Kidney is the root ofthe Gi 2. KI16 = SP is mother of LU | | and grandmather of KI ‘Treatment with additional points: GV 4 = Tonifies Source Qi - needle 45° upward or Tiger Thermie. ST 44 = Water point of ST ~ needle perpendicularly or Tiger Thermie or massage deeply. ‘TE 3- Loosens carotid compression to release SCM/compressed carotid. Needle obliquely or proximally.244 FORMS FORM7 NECK EVALUATION FORM Patient's name:__—_ = _ Date: —— Major complaint and accompanying symptoms:___ a Check yes if the neck area is normal, no if it is not. ‘Area of the neck to examine | Clinical significance Yes | No | Treatment a 1. Evaluation of the With palpation, needles, sternocleidomastoid intradermals, or moxa muscle (SCM): Right side = sympathetic nervous. system disharmony; Left side = parasympathetic nervous ‘system disharmony ‘a. muscle itself For R use KI 6; for L use KI 7; for both use TE 5R, GB 4iL | | Can also use TE 3R or bilateral b. STS area ‘Same as above plus possible thyroid problems - see #4 ‘Same as above or needle or massage ST 9 °c. posterior border (TE 16 area) Immune system response (overworked or active battle) Moxa Naganos or moxa local TE 16 area with Tiger Thermie 2. Scalene muscle evaluation: ‘a. height of muscle (GB21 |a. area) (scalene ‘compression of b. underlying Blood vessels and nerves) Tight, hard, rock-like = scalene ‘compression One side hard/thick, one side soft/thin = scoliosis Needle LU 7, massage, intradermal Needle LU 7, massage, intradermal This can lead to Blood Stasis, pattern in the occipital region 3, Supraciavicular fossa evaluation: ‘Sends Qi and Blood to the ‘a. brachial plexus musculature of the upperlimbs | involvement Tiger Thermie or needle ST 12° or massage b. vertebral artery ‘Sends Blood to the brain, head Tiger Thermie or needie ST 12° | or massage cc. subclavian artery Source of Blood flow to the upper | Tiger Thermie or needle ST 12° i meee | iymphatc dct congenton | limbs | d. left ST12 Heart Qi Xu | Tiger Thermie or needle ST 12" or massage ©. right ST 12 Spleen Qi Xu with Damp, right i Tiger Thermie or needle ST 12" or massage 4, Thyroid evaluation KI Gi, Essence, Yin Xu, with Fire. | | Hypothyroid = KI Qi or Yang Xu; Hyperthyroid = KI Yin Xu with Fire | ‘Check ST 9, LI 18 and height (top) of SCM muscle, KIS | 5, Fat pad at GV 14 ‘Adrenal exhaustion (severe KI Yang Xu) Needle GV 14 or moxa Can add GV 4, KI 6, KI16 or Ki27 . Blood Stasis patterns in | Blood Stagnation {___ the occipital region Bloodletting techniques, see Table 16.1 “Remember, when needling ST 12, position patient in the lateral recumbent position. Do not obtain Gi