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Module 4   Lesson 9   Qie Zhen, Wen Zhen

Palpation, hearing and smelling

What do your hands, ears and nose tell you that the pulse and the tongue do not?

After this lesson you can palpate the skin, limbs, chest, abdomen and points with three fixed questions, read voice, breathing, cough and odour for Excess, Deficiency, Heat and Cold, link sound and odour to the five Zang, and recognise the findings that go to a doctor first.

Feeling 切 skin: warmth, moisture limbs: cold, oedema chest: xu li, flanks abdomen: soft or hard points: Shu and Mu rule pressure helps: Deficiency pressure worsens: Excess warm Heat, cold Cold Hearing 闻 voice and speech breathing cough hiccup, belching, sighing the five sounds rule loud and coarse: Excess soft and weak: Deficiency sudden: Exterior or Excess Smelling 闻 body and sweat breath stools and urine discharges the five odours rule strong odour: Heat little odour: Cold rotten, sweet: medical first no single finding decides: weigh it with tongue, pulse and history
Textbook knowledge, after Maciocia ch. 25 (palpation of the skin, limbs, chest, abdomen and points, pp. 389 to 396) and ch. 26 (hearing p. 397, smelling p. 399). 闻 wén means both hearing and smelling (module 1, lesson 10). Schematic.

Know by heart

  • Three rules. Pressure: better is Deficiency, worse is Excess. Warmth: warm is Heat, cold is Cold. Sound and odour: loud, coarse and strong is Excess or Heat; soft, weak and odourless is Deficiency or Cold; mnemonic: what pushes back is full, what gives way is empty.
  • Skin and limbs. Back of the hand warmer: Exterior; palm warmer: Interior, often Yin deficiency. Everything cold: Yang deficiency; cold hands with a warm trunk: Qi stagnation. Oedema that pits: Water from Yang deficiency; without pitting: Qi stagnation (textbook knowledge).
  • Chest. The Great Luo of the Stomach, xu li, below the left nipple: the beat of the Gathering Qi (Zong Qi) (Su Wen 18). Tension and pain below the ribs: Liver and Gall-Bladder.
  • Abdomen and points. Soft, cool and better with pressure: Deficiency; hard, warm and worse with pressure: Excess. Ji is fixed (Blood), ju comes and goes (Qi). Tenderness at a Back-Shu or Front-Mu point points to its organ; mnemonic: ji is a building that stays, ju is a crowd that gathers and disperses.
  • The five sounds. Shouting Liver, laughing Heart, singing Spleen, weeping Lungs, groaning Kidneys (Su Wen 5; Maciocia ch. 5 p. 103); mnemonic: the voice follows the emotion: anger shouts, joy laughs, pensiveness sings, sadness weeps, fear groans.
  • The five odours. Rancid Liver, scorched Heart, fragrant Spleen, fishy Lungs, putrid Kidneys (Su Wen 4); mnemonic: from the forest (rancid wood) via the fire (scorched) and the bakery (fragrant) to the sea (fishy) and the swamp (putrid).
  • Red flags. A pulsating mass in the abdomen, a hard abdomen with severe pain, a swollen warm leg on one side; breath that smells of acetone, urine or something sweet and musty; sudden slurred speech; coughing up blood: see a doctor first, some at once.

The rest of this lesson is reference.

Palpation, hearing and smelling: What do your hands, ears and nose tell you that the pulse and the tongue do not?
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Three practice questions from this lesson

Abdominal pain that eases when you lay a hand on it and press.
  1. Deficiency
  2. Excess
  3. Blood stasis

Answer: Deficiency. Better with pressure is Deficiency, worse with pressure is Excess. Blood stasis gives a fixed, stabbing pain that cannot bear pressure.

The back of the hand feels warmer than the palm, in someone who has been ill since yesterday.
  1. Exterior: a pathogen at the surface
  2. Yin deficiency: the palm is warmer
  3. Qi stagnation: cold hands, warm trunk

Answer: Exterior: a pathogen at the surface. Textbook knowledge: back of the hand warmer is Exterior, palm warmer is Interior, often Yin deficiency. Cold hands with a warm trunk fit Qi stagnation.

Cold hands and feet, but trunk and abdomen are warm; irritable, sighs a lot.
  1. Yang deficiency: the trunk is cold too
  2. Qi stagnation (pattern 1)
  3. Full-Cold that is stuck

Answer: Qi stagnation (pattern 1). In Yang deficiency trunk and abdomen are cold as well. Cold limbs with a warm trunk fit Qi stagnation: the Yang does not reach the limbs (textbook knowledge; pattern 1).

The rest of this lesson

In the course you get the step-by-step explanation, 15 case-based practice questions, 25 spaced-repetition flashcards, the pitfalls and the bridge to physiology with evidence grades. This lesson belongs to module 4: Diagnosis.

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