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HARA DIAGNOSIS
Diagnostic Techniques

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Description
Conventional Medical Opinion
Consulting A Practitioner

DESCRIPTION
Hara is the Japanese word for abdomen. "Feeling" the hara is an
important diagnostic technique in Japanese medicine, and is
widely used by practitioners of shiatsu massage. It is, however, a
far older practice than shiatsu - its roots lie in Traditional Chinese
Medicine and in the theory of the meridians, which are channels of
Ki, or "life energy".

This Chinese chart maps the internal organ for diagnosis.

Hara diagnosis is said to work by relating different parts of the

abdomen to different internal organs and meridians. The hara can
be interpreted and "mapped" using various systems; one of the
simplest is shown below.

The abdomen is divided into the three regions

of the upper, middle, and lower body
respectively.

CONVENTIONAL MEDICAL OPINION

Western medical practitioners do not accept the theory of ki and
internal energy channels. They are likely to view as even more farfetched the idea that ki can be assessed and the condition of
organs in the body diagnosed by feeling the abdomen.

CONSULTING A PRACTITIONER
Ki is said to enter the body in the breath and to be channeled
through the meridians to the organs. It is "stored" in the abdomen
in an area called the "tanden", just below the navel. In hara
diagnosis, the patient is asked to relax and breathe deeply to allow
ki to circulate fully. The practitioner then gently presses the tanden
and other areas on the abdomen to assess the circulation of ki.
Any disturbances in the flow are thought to lead to illness.
HARA BREATHING
Concentrate on conception Vessel 6 (three-finger's width below
your navel) while breathing deeply in to the lower abdomen, let
your diaphragm come out as you inhale. Feel the breath being
expanded into the depths of the belly. Exhale, drawing the belly in,
letting the energy circulate through to body. The exercise will
strength the general condition of the body.

HARA DIAGNOSIS
By Michael Tierra
www.healthymagnets.com

Huang Ti Nei Ching Su Wen (Yellow emperor's classic) the first important written

text on Chinese medicine written around 2674 B.C. It records discussions between
Huang Ti and six officials about the problems of medicine. Probably the Yellow
Emperor's classic is a compilation by many scholars who used Huang Ti's name
for authenticity.
The original nei ching consists of many parts of which the most important are the
"Su Wen" and the "Ling Shu." The former deals with physiology, pathology,
etiology, and health maintenance; the latter with anatomy, treatment, and the
nervous system.
The "Su Wen" introduced the following methods of treatment:
1. Huei Shi cutting stone early surgery using stone knives, performed
along the Eastern coast in Shan-Tung province.
2. Medicinals: Decoctions and medicinal soups used in Shan-Si province,
Western China.
3. Acupuncture: Practiced in the plains of Southern China, Hu-Pei
Province.
4. Moxibustion: Heat therapy preferred in the highlands of Northern China,
Ho-Pei Province.
5. Massage: Manipulation and exercise which was popular in the plains of
Central China, Hunan Province.
During the Warring States era (402-221 B.C.), Tsou Chien proposed the Five
elements theory which compared the human body to a small universe.
The Nan Ching or classic of difficult issues was compiled probably within two
hundred years after the Nei Ching. It pertains more strongly to medical issues that
relate to the practice of acupuncture.
Chan Chung Ching (about A.D. 142-220) was the most famous herbal clinician
writing the Shang Han Lun (Treatise on Febrile Diseases caused by Cold) and the
Ching Kuei Yao Lueh (Summaries of Household Remedies. He formulated the
principle of the Six stages of Disease and the formulas which are described in his
books are among the most revered and form the basis of Kanpo (JapaneseChinese Herbal Medicine).
Palpation as one of the four diagnosis of Chinese medicine includes taking of the
pulse, palpating the shu (bladder) points on the back, palpating the xi-cleft points
on the meridians and palpating the mu points on the abdomen which is the basis
of Hara or abdominal diagnosis.
Some quotes concerning abdominal palpation from earlier texts:
From Essential Prescriptions from the Golden Chest (200-300 B.C.)
"When one palpates an abdomen that is swollen and full, and the patient does not
feel pain, this indicates vacancy. If the patient feels pain, this indicates repletion.
Therefore with replete patients, one must address and eliminate the repletion."
In the Shang Han Lun, shao yang stage disease the patient feels subcostal
fullness. There may be sensation of a lump or tightness below the heart and a
general feeling of stagnation.
The Japanese physicians have developed hara diagnosis most extensively. Todo
Yoshimasu described the types of lumps and location as follows:

The Nan Jing abdominal correspondences outlining the five phase diagnostic
model is as follows:
Liver pulsing lump, tightness or pain on the left side of the umbilicus. Japanese
practitioners tend to center this area just below the umbilicus on the lateral left
side of the abdomen which roughly corresponds to the location of the portal vein.
Spleen around the umbilicus
Lungs right side of the umbilicus
Kidneys below the umbilicus
The so called "Mu" or mother points of the abdomen are as follows:
1. Liver 14 - liver
2. Liver 24 - gall bladder (?)
3. Gall bladder 25 - spleen
4. CV12 - stomach
5. CV 3 - bladder
6. CV 4 - kidney
7. Lung 1 - lung
8. Stomach 25 - large intestine
9. CV 15 - heart
10. CV 14 - Pericardium
ll. CV 17, 9, 4 - triple warmer
12. CV 4 - small intestine
These can be used for diagnosis and treatment, in fact CV 12 is considered the
command point for all the internal yang organs of transportation while Liver 14 is
considered the command point for all the internal yin organs of transformation.
Further CV 6 is considered the sea of chi, CV 9 is considered a point that governs
water metabolism, CV 25 is a point that is considered the great eliminator, Spleen
15 and 16, especially on the left, are points that are used to stimulate intestinal
peristalsis, point on the lower abdomen such as CV 3 (an important point for the
chong mo meridian), stomach 29, 28, 27 are considered very important for
gynecological problems, especially blood stagnation syndromes in women.
WHAT TO FEEL FOR:
Temperature Variations: Feel the four quadrants and determine temperature
variations, also compare the three warmers with each other. Many patients are
cooler below the umbilicus and warmer above. This represents counter flow chi
with vacancy in the kidneys and fullness above.
Tension: Tension or lack of tension should be observed, especially below the
rib cage and along the rectus abdominal muscles. Tension usually represents
vacancy rather than repletion. Lack of tension in the muscles is a good sign
indicating an elastic, healthy abdomen. The release of tension is a prerequisite for
healing.
Pressure Pain: Pressure pain found on palpation points is almost always of the
utmost significance. Severe or sharp pains are more significant than dull, achy
pains. Pain is usually considered a repletion sign of stagnation. If it is relieved by
touch or pressure it is a sign of vacancy.

Sometimes psychological issues can exaggerate abdominal sensitivity. Check SP10, ST-36 to ST-38 and between the 3rd and 4th toes. If there is any reactiveness
on any or all of these points, shiatsu would be an appropriate therapy. These
points can also relax the abdomen, making it less sensitive, allowing one to
resume abdominal diagnosis.
Fluid Sounds: Whenever sloshing or gurgling occurs in the subcostal region it
usually affects the stomach. It represents fluid stagnation in the stomach.
Traveling or Reactive Sensations: Sometimes when palpating a particular area
there is a sensation or reaction that seems to travel to certain areas of the
abdomen. These can occur anywhere in the body, including the extremities. The
most significant of these may radiate areas of the body where the patient has
problems. Check associated organs or meridians that may be involved.
Sometimes pressure on a particular area of the abdomen will eliminate a pain
occurring elsewhere. For instance pressure on the abdomen can cause or relieve
corresponding back pains. Other areas near the liver or stomach may relieve a
headache.
Strength or Weakness of Abdominal Musculature: Too much strength may
represent repletion, while flaccidity, lack of tone, softness can indicate vacancy.
Tightness - Hardness & Softness - Looseness: Tightness is different from
tension. With tension there will be some rebound with tightness the is less or no
springiness or rebound. Tightness is harder to treat than tension. It signifies a
more exacerbated condition. Softness and looseness may appear similar to
weakness, except that some springiness remains in the muscles. Softness does is
not as great a sign of vacancy as is weakness.
Different depths can also be palpated:
1. Hardness on the surface and hardness below.
2. Hardness on the surface and softness below.
3. Softness on the surface and hardness below.
4. Softness on the surface and softness below.
5. Palpation around the midline will reveal softness on the surface and
hardness below.
Lumps: Lumps have varying significance depending upon their location, size,
and quality. Lumps may be soft or hard; stationary or mobile. Moving lumps are
more yang in nature and easier to treat. Stationary lumps are more yin in nature
and more difficult to treat. Rule out the possibility that some lumps may be gas or
stools in the intestines.
Most lumps are not tumorous, but consists of knots of muscle or other tissues.
Usually if a tumor feels smooth and not irregular it is probably benign, if it has
irregular edges it could be more dangerous. It is generally advisable to not palpate
directly on a lump but around it.
Pulsing or Palpitations: Such symptoms and signs are usually an indication of
vacancy. Their significance varies with their relative strength, depth and location.
Some are visibly obvious, indicating greater vacancy. Sometimes it can be felt
with slight pressure and others only with deeper pressure. It will have varying
strengths.

A slight pulsing around the umbilicus is normal. It is considered the moving chi of
the kidneys and is a favorable sign of health.
Skin Qualities & Textures: Loose, creased skin may indicate vacancy while
tight skin may be a sign of repletion. Healthy skin will "pinch up" easily between
the thumb and forefinger, evinces a normal springiness. If it is tight it will be
difficult to pinch the skin, if it is loose it will be easy to pinch it. In extreme
vacancy, when the skin is pinched it remains pinched and will not return to
flatness.
The skin pinching technique can reveal various sensations including tightness,
tension, small lumps and sometimes vague symptoms of "something there." It is a
way of diagnosing the most reactive points and those points where a patient is
under-sensitive. It is the most useful method for determining sensitivity. Some
Japanese practitioners use the pinching with great dexterity and skill, being able
to diagnose the entire hara and the lengths of meridians in just a few minutes.
Skin texture is also very important:
1. Dry skin represents vacancy.
2. If the skin is too moist it is generally not a good sign.
3. Some skin moisture, but not too much is normal.
4. Roughness, smoothness, color tones, paleness or redness may all have
some significance.

Swellings & Indentations: Swollen or indented areas are usually palpable.

Swelling is a sign of repletion while an indentation is a sign of vacancy. In general,

when we speak of signs of repletion such as tension, tightness or swelling it is
generally a sign of vacancy so that these signs are to be considered a kind of false
repletion (yin deficiency).

Chart is available from Acupuncture Products (See Link Below).

RELATED LINKS
Acupuncture Products: Shiatsu Chart of Meridians & Hara Diagnosis
The Shiatsu Man: The Hara
AcupunctureMedical.org: Hara Diagnosis (PDF)