經方學

It takes practice this abdominal diagnosis method. It is not just a matter of feeling where there is tension, or where the patient experiences discomfort. Getting a sense of how differences in skin, moisture, innate muscular tension, where there is fullness, and how emptiness can be easily not found are all part of the process.

The more I touch patient’s abdomens, the more I approach it with a sense of inquire and curiosity, rather than with the demand to find something, the more I discover patterns and presentations that at times lead to a clear sense of a patient needs, and at other times leads to further questions.

Here is part two of the abdominal palpation article that Steve Clavey and I did last year. It originally was written in Japanese, translated to Chinese where I found it in Taiwan, and then appeared for the first time in English in The Lantern, which of course, you are already subscribed to.

What? You haven’t yet?  Well, then click below, and remedy that situation!

Through the miracle of MP3, I’ve been having discussions with Dr. Huang on my morning walks to work. Actually, re-listening to the discussions we had in Nanjing. But, since words in Chinese have this sneaky way of going transparently through my ears when engaged in thinking and making sense, listening again to our conversations yields all kinds of new information.I have recently begun to translate the Ma Huang (麻黃類方) chapter, and in the Ma Huang Constitution it includes the sign of “aversion to cold.” People with the Gui Zhi Constitution also have that. So, I asked Huang about it.

This feeling of aversion to cold, is it different for Ma Huang and Gui Zhi types? 

His answer was surprising to me in that it had little to with the patient’s subjective sense, and more to do with an intersection of their feelings and objective perception of the practitioner.

Yes, they are different. The Ma Huang type has sensitivity to cold, but there is a lack of sweating, their skin is course and even sandy looking. Those Gui Zhi types, they also dislike cold, but their skin is fine, moist, and tends to be pale. 

It is not helpful to simply go on what the patient says. People all have different ways of experiencing themselves and body. Of course, listen to a patient’s subjective experience, but then back it up with your own objective observation. There is a more dimensional image that emerges when the observable and reported mutually inform each other.I rather like this approach of Dr Huang’s. That there are concrete physical signs that help us to differentiate a patient’s particular constitution. It is this background, along with the various signs and symptoms that help us to to determine how best to help a patient.It is not just a matter of what symptoms are present, but more importantly, the kind of person that is having those symptoms.

It is not common in the practice of acupuncture to use palpation as a method of gathering information to help one decide on a course of treatment. In herbal medicine, this has been a much less used method. At least here in the United States.

When living in Taiwan, I came across a book called the Medical Dictionary of Kampo Diagnosis and Treatment, (漢方診療醫典 Han Fang Zhen Liao Yi Dian), it was written by Dr. Otsuka Yoshinori, a Japanese practitioner of Chinese medicine, and translated into Chinese. It is a fine collection of the author’s clinical experience, written in a refreshingly candid fashion. Most interesting to me, was a section in the front, where he outlines a variety of abdominal patterns which indict which classic formula would be appropriate.

Abdominal signs are discussed in both the Ling Shu and Su Wen in the Yellow Emperior’s Internal Classic. While it appears abdominal diagnosis was a part of Han dynasty medical practice, and indeed there are lines in the Shang Han Lun that mention palpatory abdominal findings, it fell out of favor in later years. In Japan, however, that portion of the tradition has been preserved, and is part of the Kampo (漢方 han fang) tradition, where abdominal signs are the confirmation for prescribing various formulas.

The translation of this material on abdominal palpation and formula selection was a collaborative effort with Steve Clavey, editor of the fine Australian English language journal on Chinese medicine, The Lantern, where this article was first published. Get it here: SHL Abdominal Patterns I

While Michael Max and Steve Clavey retain the copy write on this article, it may be downloaded for individual use.

Watch for part two, coming to this blog in the near future!