Channel and point palpation TCM practitioners must carry out careful examination of the body surfaces so as to detect

any abnormalities such as points of tenderness, warmth, skin eruptions and subcutaneous nodules. These phenomena are then linked to the pathology of a neighbouring channel.

Method of examination
The thumb is rubbed lightly over the skin along the course of a channel, or the thumb is used together with the index finger to knead the skin gently in order to

detect alterations in the superficial cutaneous layers. A greater degree of pressure may be needed to probe the deeper layers of skin. It is important that the pressure be uniform, however, and that the clinician notes any differences between the same channel on the left and right sides of the body. Ordinarily, examination begins along the channels of the back and then proceeds to the chest, abdomen and limbs. Particular attention should be given to special points such as the Back Transporting

(Shu) points, Front Collecting (Mu) points, Source (Yuan) points, and Accumulation (Xi) points.

Abnormalities
These include subcutaneous nodules, area of tenderness, hard or flaccid muscle tissue, and indentations, or discoloration of the skin or change in its temperature. Once discovered, it is necessary to determine whether the abnormality reflects symptoms of Excess or Deficiency in the related channel.

Clinical application
The following method is used in examination of the

back. The thumb is pressed along the left and right sides of the spinous processes (the medial course of the Bladder channel), generally beginning beside the 12th thoracic vertebra and working upward to the first thoracic vertebra, and then from the sacrum up to the lumbar vertebrae. When this is complete, the skin surface in the vicinity of the ilium and shoulder blades may be similarly palpated. In addition to the abnormalities discussed above,

attention should be paid to the position of the spinous processes and any abnormalities in the tissue tension of the paraspinal musculature. Such areas may be sensitive to the touch. The practitioner should also check the vertebrae to see whether they are evenly spaced or if there is any scoliosis. If any abnormalities are found that indicate a strictly local problem these are treated accordingly. The remaining may be regarded as External manifestations of an internal disease:

 commonly, abnormalities discovered between the first and third thoracic vertebrae suggest an illness related to the Heart those between the first and fourth are related to the upper limbs those between the second and fifth are related to the Lung and bronchioles those between the fifth and eighth are related to the Stomach and duodenum those between the eighth and 10th are related to the Liver, Gallbladder and pancreas

 those between the 10th and 12th are related to the Stomach and intestines those between the 12th and the second lumbar are related to the Kidney and urinary system those between the first and fourth lumbar vertebrae are related to the lower limbs those in the sacral region are related to the reproductive organs. 38 general introduction Because these lines running parallel to the spine correspond to the course of the Bladder channel, the Back Transporting points along this channel are

frequently palpated for diagnostic purposes, as are the Front Collecting points on the chest and abdomen. In practice, these points are considered the primary diagnostic indicators. The acupuncture points on neighbouring channels may also be checked for reaction for instance, the Front Collecting point LU-1 Zhongfu and the neighbouring point KI-27 Shufu may reflect the condition of the Lung and bronchioles. When palpating points on the limbs, the

Accumulation points are considered to be of primary importance, and the neighbouring points are secondary; for example, the Accumulation point ST-34 Liangqui and the neighbouring point ST-36 Zusanli may both reflect Stomach disease.