Volume 2, Number 1 | Spring 2007

Introduction of Japanese Acupuncture

palpation of the abdomen, (abdominal palpation)

Considering the Therapist’s Hand (5)palpation of organs (organ examination) based on

Shuichi Katai, Ph.D., L.Ac., Professor

modern medical theory may indicate hypertrophy or

Department of Acupuncture and Moxibustion

sclerosis of the liver, or swelling of the kidneys.

Tsukuba University of Technology, Ibaraki, Japan

However, when adhering to the classical theory, it is
not the organs that are palpated, but oriental medicalIV. How are the hands trained?
Factors influencing the hands of therapists can begrossly divided into two groups. In other words, thekind of hands therapists develop is based on"differences in therapeutic concepts" and "differencesin therapeutic modalities".

comprehension aims rather at understanding thecondition of the abdominal skin, connective tissue ormuscles.

This

can

differences in therapeutic concepts
Based on differences in therapeutic concepts thesites (tissues) from which the gathering of information
is attempted differs, and therefore the requirements of
the hands performing the palpation differs as well. For
example, depending on whether the therapist bases
his/her practice on classical or modern medical theory,the purpose of the palpation will be different.
In case of classical theory the theoretical foundation
will be vitalism and humoral pathology, requiring
comprehension of concepts like stagnation and flow of
Qi and Blood. For this reason the hands have to be
trained to be able to perform pulse and abdominal
diagnosis, palpate the meridians, check the conditionsof the acupoints and the like. The skin, subcutaneous
tissues, muscles etc. will be palpated from the point ofYet, on the other hand, if modern medicine serves
as theoretical basis, solid pathology becomes thefoundation and it will be necessary to comprehend thecondition of tissues (sometimes organs) and perform
palpatory examinations on the basis of a knowledge ofphysiology and anatomy. Palpation will be performed
using concepts like dermatomes, trigger points or
Head's zones etc. This allows us to gain insights into
the position of bones or the course of muscles inand kidneys with regard to the abdominal diagnosis
names are associated with the names of organs andviscera, that do not really indicate those organs itself.
For example, kidney yin deficiency may not bediagnosed as the western “anatomical” kidney. On thecontrary, for the palpation of liver cirrhosis, the liver
will be palpated through the skin, connective tissue
and muscles. The purpose of the palpation is to feel theliver parenchyme.
2. Differences in palpating hands based on differencesin therapeutic modalities
In cases of differences in therapeutic modalities,
there are specific aspects palpation is used to ascertain,
so that the required palpatory skills differ. In this case,the target tissues vary depending on the therapy
applied during treatment. Table 5 shows a number oftherapies, but here I would like to describe the kind ofpalpation required for those therapies (Table 5).

Therapy
Acupoint therapy
Ashi point therapy
Treatment
musclesofTreatment basedon pulse diagnosis
Use of tools

examinations is also required.

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when

considering the designation of liver, heart, spleen, lung

addition to which an understanding of neurologicalexample,understood

Table 5 How is the hand trained?

view of classical theory.

forbeaccording to the Gosei-ha. Or in cases when disease

1. Differences in the palpating hands based onSpecifically,

easilywhenconsidering

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Goal of palpation...
determine
location
andreactivity of acupoints... identify tender or indurated
regions... comprehension of muscles,tendons and ligament (trigger
point therapy, pulse therapy etc.)... identification of the conditionof the pulse (strength andcondition of the pulse)... identify stimulation sites

Volume 2, Number 1 | Spring 2007

the muscles. This may be due to a trend towards(1) Acupoint therapy
For therapies with the aim of stimulating acupoints,

deeper needle insertion or using stimuli strong enoughit would suffice to be able to acquire those acupoints

to have the patients realize that the needles areaccording to the descriptions given in the textbooks. In

inserted to a certain depth. Palpation related to thisother words, this requires learning the position of thekind of needle insertion should provide insights into

361 acupoints and practice to be able to locate those

thepositions precisely. Accordingly, it should be sufficient

information pertaining to the skin or connective tissue

to understand and be able to apply the bone-standard

is rather unimportant. Accordingly, modern anatomy

measurement and body inch method.

andconditionof

physiology

muscles

canbeandligaments.

appliedwithout

Here

any

However, an understanding of the location of themodifications. However, during actual needling, theacupoints is a minimal requirement, the location of thequestion where a particular muscle of a given size

acupoints is not simply a question as to how many

should be needled emerges. Therefore, the condition ofinches a certain point is separated from a particular

the muscles must be observed in detail during thebone. Clinical practice therapy will require searching

palpation, and the palpation must help identify

for acupoints mainly in the vicinity of the locations

appropriate points for needling.

given in the text books. Accordingly, acupoint therapy
too, even if performed strictly, requires looking for
detailed local and distal reactions. For this reason it isnecessary to train the hand in order to make themcapable of detecting subtle vital reactions on the bodysurface.

Ashi point therapy treats the sites indicated by thepatient, so that it has been considered a therapy
without theoretical foundation. Since needles areinserted into painful areas, a certain degree oftherapeutic effects can be observed and the patient issatisfied. Therefore, the therapeutic goal can be said tohave been achieved to a certain degree.
However, if ashi point therapy real effects are to beobtained, the therapeutic sites within the areas theiscomplaining

Pulse diagnosis: Since the pulse condition should beunderstood for the treatment, detecting minutevariations in the pulse is required. Yet, if only thepulse was observed among the multitude of reactions
the body shows, and none of those other reactions were

(2) Ashi point therapy

patient(4) Treatment based on pulse diagnosis

about

must

befirmly

established. In other words, determination of the final

considered significant, it would be necessary to firstestablish a system of correlations between those otherreactions and the pulse through comparative studies.
Moreover, if an acupoint has been chosen in responseto the pulse diagnosis (for example one of thecommonly used five element points) and its position
has

been

determinedusing

thebone-standard

measuring, in actual practice an even more exact
determination of its location would depend on thepalpatory skills of the practitioner.
(5) Use of tools to determine treatment sites

needling sites requires, not surprisingly, examination

In case a dermometer or equipment for Ryodoraku

of the relevant reactions, so that it is necessary totherapy is used, a detailed palpatory examination isperform a detailed palpation in order to comprehend

not necessary, since the results of the measurements

those reactions.

determine point locations. Then the locations of theacupoints can be deducted using the bone-standard(3) Treatment of muscles
Although there are probably no therapists who

measuring. Yet, because this is also a special form ofconsider the lesion to be located exclusively in muscles,

acupoint therapy, practitioners have to face in the end

there may be a substantial number of therapists, who

the same problems already described above in theeventually are able to establish a treatment targeting

section on "Acupoint therapy".

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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