Volume 2, Number 3 | Fall 2007

Introduction of Japanese Acupuncturewith the hands, it is definitely not done solely with

Considering the Therapist’s Hand (7)the fingers or the wrists alone. The entire body

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

should concentrate on the palpation and that its

Dept. of Acupuncture and Moxibustion

complete

Tsukuba University of Technology, Ibaraki, Japanpalpation.

involvement

iscrucial

toeffective

Table 7 Basic training of the hands IIV. Basic training of the hands- Placement of the hand -2. Palpation posture
Next I will describe the way the hands should be1) Place first the wrists and then the fingertips
2) Form an arch with the palms and fit them toplaced and the posture (Table 7).
Detailed findings of the body surface are felt

the body form

with the fingertips, but trying to perform the2) Don't spread shoulders or elbows

palpation solely with the fingertips renders the3) Keep wrists and fingertips parallel to the bed

patient most uncomfortable. It would be advisable
to place the entire palm in close contact with theregion to be palpated, or else form the hands into ashape similar to that of the examined body region
from a little distance and then bring the fingertips
into contact with the body. Also, conscious efforts
should be made not to use the fingertips per se forthis task, but rather perform the palpation fromthe wrist, using the entire palm.
Shoulders and elbows should not be spread out

surface (or the surface to be palpated)
3. Acquaintanceship / Familiarity / Putting thepatient at ease
During palpation the things listed in Table 8
should be taken to heart. It is important to avoid
making the patient uncomfortable by trying toobtain the necessary information quickly andabruptly. These two items may appear to becontradictory, but both are necessary to obtainpalpatory information. Therefore, although underand both wrists and fingertips kept parallel to theparticular circumstances there may be a certain

target area during the palpation. When sitting on adegree of inconsiderations pertaining to pain,

chair, the upper half of the body should rest on the

discomfort or shame of the patient (occasionallyhips, the back positioned directly above the pelvis,

even disregard), if at all possible, attempts shouldarms extending effortless from their base at thebe made to perform the palpation from the point ofshoulder and palms positioned at the end of them.

view of patient. Moreover, attempt to acquire theIn other words, hips, back, shoulders, elbows,

skills to aptly obtain the necessary information.

systematicallyAlso, it is important to take care not to expose

together. It is important to realize this. Naturally,

the patient's skin more than necessary. The skillfulonce this posture becomes comfortable, it will nouse of bath towels to cover the patient and arrange

longer be necessary to concentrate this flow ofthings for this purpose assures that only the area

movements and the practitioner can concentrate

to be palpated is exposed. Prepare two bath towels

completely on the area being palpated. Also, whento cover the patient, covering the upper and lower

standing, both legs form the foundation of thehalves of the body separately. Skillful use of thesewrists,fingertips

arelinkedposture, the hips are placed on top of the legs andtwo towels allows elegant exposure of only thethe remaining upper half of the body again

necessary areas.

assumes the same posture above the hips as when

4. Evaluation of the palpation and therapeutic

sitting. In short, although palpation is performed28

effects

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

Volume 2, Number 3 | Fall 2007

This is related to the following section on

be examined. First, muscle tension and stiffness

practice methods, but the question as to whether

shouldbeunderstood

distinct

fromtension,

the information obtained through palpation isswelling and tone of the skin and connective

really appropriate or not, requires that thetissues. This is a skill that is comparatively easy topractitioner constantly and repeatedly questionacquire, because the practical training duringhim/herself. Until intuition upon touch produces

regular schooling usually focuses on the acquisition

the correct results, repeated self-questioning isof information pertaining to tension, stiffness andvery important.

similar 'excess' information. By graduation, theDuring palpitation confirmation of the sensation

skills of palpation for excess conditions andobtained from the fingertips through touch is areactions are often fairly well developed. Actually

recollection of the past. It is a comparison withtension and similar signs of excess are rather easy

memories of what one has felt through touch in theto comprehend.

past to verify the current sensation. However,Once you have learned to assess excess, you

many people have little experience of touchingshould try and practice to obtain information aboutother people and the available memories from the“deficiency”. One example of a practice method

past are not very clear either. It is therefore

would be to practice and palpate the round shape ofnecessary to establish one's own set of sensory

subcutaneous veins or foveations in the skinmemories. This process requires some time andwithout applying too much pressure. This form of

will be associated with a strong feeling of fatigue.

palpation should be done by gently sliding yourYet, once this stage has been passed, it becomes

hands over the skin without applying too much

possible to comprehend reactions without muchpressure.

conscious effort based on the thus established

Always confirm with your teacher (master),whether your sensation is correct or not. Also, it ismemories.
Table 8 Basic training of the hands III- Help the patient relax 1) Warm your hands
2) Don't use unnecessary pressure3) Don't let the patient feel any pain4) Always scrutinize your own sensation
5. Practice methods
Now I would like to describe some practicalmethods for improving palpation skills (Table 9).
During practice it would be good to blindfold
yourself or use other means to block vision, so thatyou can concentrate on touch without being
distracted by visual information. As I havedescribed in this paper on the training of the hands
under (- Object -), it is important to clearly
distinguish during practice between the tissues toadvisable to practice in a way that inspires thepatients to ultimately tell you, that your "hands
are warm, soft, pleasant and comforting".
Table 9 Palpation targets* Skin (surface) -> The feel of the skin, degree oftension, irregularities, temperature, degree ofmoisture, alterations etc.
* Skin (deep) -> Tone of connective tissues,hardness, arteries and veins, indurations,edema etc.
* Muscles -> Tone of muscles and tendons,tension, swelling, lack of power, indurationsetc.
* Organs -> In acupuncture and moxibustion
therapy organs are not the subject ofpalpation, but you must be aware of theirrespective positions* Bones -> Bones are important as anatomical
landmarks and for acupoint location.

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

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