How to detect wellness through “palpation inspection”

Finger touch examination method, also known as “finger touch assessment method”, involves the masseur gently touching the body surface (skin) with the palm or fingers or pressing down with slight force, carefully exploring and sensing the skin and subcutaneous tissue to understand relevant wellness conditions and assist in assessment and supports.

In clinical medical massage, the finger touch examination method is an extremely important diagnostic approach. From a practical perspective, “touch” (触) and “feel” (摸) are fundamentally distinct. Touch involves gently contacting the skin surface with the fingertips to assess skin temperature (cold or hot), moisture (damp or dry), texture (rough or smooth), and the presence of abnormal surface reactions. Feel entails applying slight pressure with the fingertips to palpate and explore the body’s constitutional health status, detecting abnormal changes in subcutaneous tissues—such as muscles, tendons, fascia, ligaments, major and minor blood vessels, bones, joints, interarticular spaces, and internal organs within body cavities—including subcutaneous nodules, swelling, or masses.

The finger touch examination method mainly includes two parts: “touching abnormal body posture changes” and “touching tender reaction points”. The relevant contents are described as follows:

1. Abnormal body posture changes upon touch

(1) Skin: It is normal when the skin has an appropriate temperature and an optimal balance between moistness and dryness.

Skin that feels burning hot to the touch indicates heat, while a cold sensation indicates cold.

At the initial press, if the skin feels extremely hot and the heat subsides after prolonged pressing, it indicates exterior heat; if the skin feels cool at the initial press but becomes increasingly hotter after prolonged pressing, it indicates interior heat.

Softness of the skin and muscles indicates deficiency, while hardness indicates excess.

Mild pressure causing pain indicates an exterior wellness; deep pressure causing pain indicates an interior wellness.

Dry and cracked skin indicates fluid injury; moist and sticky skin indicates excessive dampness; a cold sensation upon touch indicates severe cold.

Subcutaneous elliptical nodules that can be moved when pushed and do not disperse when pressed are phlegm nodules and goiter; subcutaneous cord-like nodules that can be moved when pushed, disperse when pressed, and cause a pricking pain when compressed indicate blood stasis.

When the skin is swollen, if it rebounds immediately upon pressing, it is pneumatosis; if an indentation remains after pressing and the skin does not change color, it is edema; if the skin is swollen and accompanied by a bluish-purple color, it is hematoma.

(2) Head and Neck: Shiny and lustrous hair indicates sufficient essence and qi-blood.

Dull yellow and dry hair indicates deficiency of body fluid and blood.

A thick scalp with a slightly soft feeling indicates severe phlegm-dampness in the head, while a cold sensation in the head indicates severe cold.

Unevenness of the scalp surface upon touch or the presence of fine cord-like structures indicates obstruction of blood vessels in the scalp, known as cerebral vascular obstruction or cerebral vasospasm.

If there are cord-like structures on both sides of the neck and at the base of the carotid arteries, it indicates carotid artery obstruction, suggesting dizziness caused by insufficient blood supply to the brain.

The cervical vertebral joints are deviated to one side or misaligned in sequence, with the head and neck forced into a fixed position and unable to rotate, indicating cervical spondylolisthesis or cervical subluxation.

The cervical vertebral joint alignment is normal, but functional movement is restricted, which is considered as stiff neck or “lost pillow” syndrome.

The cervical vertebral joint sequence is normal, and the neck movement is also free. However, the soft tissues of the neck feel stiff or partially hardened upon palpation, indicating degenerative changes in the soft tissues of the neck.

Neck pain radiating to the ipsilateral scapular region with restricted movement is termed as cervical-shoulder syndrome.

Neck pain radiating to the posterior occipital region, scapula, or upper limbs indicates cervical osteophyte formation or cervical intervertebral disc herniation stimulating or compressing the cervical nerve roots or brachial plexus nerve roots.

(3) Back and waist: A normal back and waist are characterized by plump muscles, neither too fat nor too thin, being soft and elastic. The vertebral column is in proper alignment, forming a straight line from top to bottom.

Unilateral or bilateral collapse or deformation of the costal regions indicates costal chondromalacia.

Extreme laxity of the muscles in the back and waist indicates that the spine is prone to deformation, serving as a precursor to spondylolisthesis.

The muscles on both sides of the spine are tense and stiff, indicating spasm of the erector spinae muscles in the back and waist.

Segmental swelling and pain of the erector spinae muscles on both sides of the back and waist indicate blood stasis in the erector spinae muscles.

Obvious swelling of the muscles in the back and waist area, accompanied by sharp, needle-like intense pain upon touch, indicates soft tissue injury in the back and waist region.

If, after acute trauma, the lumbar muscles are swollen and painful upon touch and the patient is unable to turn to the side, it is acute lumbar muscle strain.

There may be a history of acute lumbar muscle strain or no history of acute trauma. If the lumbar muscles feel stiff to the touch, with diffuse swelling but no obvious tender points, it is chronic lumbar muscle strain.

When the spinal alignment is normal but rigid, and the patient is unable to perform movements such as bending forward or backward or turning to the left or right, it is ankylosing spondylitis.

When several vertebral bodies at a certain segment of the spine undergo sequential displacement and deformation, it is called spondylolisthesis. Displacement forward is termed anterior spondylolisthesis; displacement backward is termed kyphosis; and displacement laterally is termed scoliosis.

A lateral sequential curvature of the spine is termed scoliosis; a protrusion of a single vertebra in the anterior, posterior, left, or right direction is termed spinal facet joint subluxation or lumbar facet joint dislocation.

(4) Chest and abdomen

A thin body with a high and protruding sternum is mostly “pectus carinatum”; a protruding anterior chest with shortness of breath upon pressing is mostly emphysema.

The Liver is located within the right hypochondrium and generally cannot be touched by hand. If an enlarged Liver, either soft or hard, is palpated below the right costal margin, it suggests Liver wellness, which may be due to Qi Stagnation or blood stasis. If the surface of the Liver is uneven, caution should be exercised for possible Liver cancer. If there is distending pain in the right costal region, with a sensation of heat upon palpation and an aversion to pressure, it is mostly Liver abscess.

Abdominal distension and fullness with aversion to pressure indicates excess syndrome; a soft abdomen that responds favorably to pressure indicates deficiency syndrome.

Coldness of the abdominal wall indicates internal cold, and a preference for warm objects to be placed on it suggests deficient cold; heat of the abdominal wall indicates internal heat, and a preference for cold objects to be placed on it suggests deficient heat.

If there is a hard mass with distension in the epigastric region that can be moved by pushing and kneading, it is food stagnation; if the mass cannot be moved by pushing and kneading and there is severe pricking pain, it is blood stasis; if there is epigastric distension and fullness with a splashing sound upon pushing and kneading, it indicates internal retention of damp-water; if there is abdominal distension and fullness with a tympanic sound upon percussion, it is Qi Stagnation abdominal distension; if there is epigastric distension and fullness with a dull sound upon percussion, it is abdominal distension caused by accumulation of solid substances.

Abdominal masses are termed as “Ji Ju” (accumulation and aggregation). When the pain has a fixed location, and the mass is palpable and immovable upon pressing, it is called “Ji” (accumulation), and the wellness is located in the blood aspect; when the pain has no fixed location, the mass is not palpable upon pressing, and it aggregates and disperses irregularly, it is called “Ju” (aggregation), and the wellness is located in the qi aspect.

Pain in the right lower abdomen that worsens upon pressure, with a palpable mass, indicates intestinal abscess (appendicitis).

During abdominal palpation, if the abdominal wall is found to be uneven with an earthworm-like wriggling sensation under the fingers, and the mass rises, falls, gathers, disperses, and moves irregularly when pressed, it indicates the presence of an abdominal worm mass.

The trick to judging food and drink in a child’s stomach is as follows: Press the epigastric region with the pulp of the finger with slight force. If numerous hard, small particles, as small as sesame seeds or as large as beans, are felt, it indicates peanut and legume foods; if densely clustered lumps, as small as mung beans or as large as soybeans, which are soft yet firm, are felt, it indicates melon and fruit foods; if lumps in the stomach are neither soft nor firm, it indicates meat foods; if there is abdominal distension and fullness, and the area feels indistinct and soft to the touch, it indicates grain foods, paste, or milk foods, etc.

(5) Hands, feet and limbs

Cold hands and feet indicate yang deficiency with yin excess or severe pathogenic cold; hot hands and feet indicate Yin Deficiency with yang excess or severe pathogenic heat.

Heat in the dorsum of the hands and feet indicates exogenous fever; heat in the palms of the hands and soles of the feet indicates endogenous fever.

When the heat on the forehead is more severe than that in the palm of the hand, it indicates exterior heat or exogenous pathogen attack; when the heat in the palm of the hand is more severe than that on the forehead, it indicates interior heat or internal injury.

When only the fingertips of a child are cold, it is a sign that smallpox is about to appear.

Generally, patients with warm extremities have a good prognosis; those with cold extremities often have a poor prognosis.

If pain occurs in the muscles and joints of the limbs, and is aggravated by exposure to external pathogenic factors such as wind, cold, and dampness, while helps with occasional by heat, it is classified as wind-dampness arthralgia syndrome; if there is swelling and pain in the joints of the limbs, accompanied by tendon contraction and restricted flexion and extension, and the pain worsens upon exposure to wind, cold, and dampness, it is classified as rheumatoid arthritis.

Rheumatoid arthritis is characterized by symmetrical joint swelling and deformation starting from the distal small joints, without direct influence from the invasion of external pathogenic factors such as wind, cold, and dampness.

Swelling and pain in the limbs’ joints, with difficulty or inability in flexion and extension, is known as joint and meridian contracture.

Compare the symmetry of both upper and lower limbs. If there are abnormal changes such as swelling or shrinkage in the muscles on one side of the upper or lower limbs, consider muscular atrophy or muscular inflammation, suggesting the possibility of cervical or lumbar intervertebral disc herniation, piriformis syndrome, or avascular necrosis of the femoral head, etc. If there is muscular atrophy in both lower limbs, consider conditions such as spinal canal stenosis, spinal canal tumor, lumbar spondylolisthesis, or central lumbar intervertebral disc herniation, etc. If there is a discrepancy in the length of the limbs, consider joint dislocation or displacement.

(6) Palpating the arterial pulsation beneath the breast: The area beneath the breast where arterial pulsation is palpable is termed “Xuli Acupoint (CV 17, Xū Lǐ Xué)”, which serves as the convergence point of pectoral qi. Upon palpation, if the pulsation is responsive to touch, moving smoothly without tension, and slow yet not feeble, it is deemed normal. If the pulsation is faint and not prominent, it indicates a deficiency of pectoral qi. If the pulsation is particularly pronounced, it suggests a leakage of pectoral qi. If the pulsation is forceful and rebounds against the hand upon pressing, it is considered a critical sign. Therefore, palpating the arterial pulsation beneath the breast can reveal the presence or absence of pectoral qi and holds significant clinical reference value.

(7) Palpating abnormal changes within the body includes three aspects: abnormal changes in the subcutaneous soft tissues, abnormal changes between the visceral tissues, and abnormal changes in the bones and joints.

Abnormal changes in the subcutaneous tissue: those located on the lymphatic vessels are called lymph nodes; those located in areas such as the back, waist, and sacrum are called goiter and phlegm nodules; masses and nodules around the joints are mostly cysts around the joints.

Subcutaneous swelling: If a cord-like swelling is palpable under the skin and there is obvious pricking pain upon pressure, it is intravascular blood stasis swelling, which is caused by the obstruction of meridian channels by intravascular blood stasis; palpation under the skin

Palpation reveals soft lumps of varying sizes; those causing pronounced pricking pain upon pressure are blood stasis masses formed by blood that has deviated from its normal pathways. Subcutaneous tissue swelling accompanied by a burning sensation upon palpation indicates inflammation.

Subcutaneous swelling: When the skin appears cyanotic-purple and there is obvious pricking pain upon pressure, it is called hematoma.

Skin swelling: Swelling that rises immediately upon pressing is pneumatosis; swelling with indentation that does not rise upon pressing is edema.

Abnormal changes among zang-fu organs and tissues: Due to physiological reasons, under normal circumstances, the five zang organs (Heart, Liver, Spleen, Lungs, and Kidneys) are not easily palpable on the body surface, while some of the six fu organs, such as the stomach, large intestine, small intestine, and bladder, can be directly felt by hand on the body surface.

A sunken upper abdomen and a distended lower abdomen presenting as a boat-shaped abdomen indicate gastroptosis.

After abdominal surgery, if there are patchy masses in the abdomen and a tearing pain occurs upon pressing and kneading, it indicates intestinal adhesion.

The left side of the abdomen corresponds to the descending colon area. A sensation akin to water waves upon palpation in this area indicates an impending onset of diarrhea. If a hard mass is palpable in the descending colon area with relatively mild pain upon pressing, it suggests constipation. If a swollen sensation is felt in the descending colon area with significant pain upon pressing, it indicates colitis.

When a woman’s lower abdomen feels cold to the touch, and there is a palpable mass that causes pronounced stabbing pain upon pressure, it suggests amenorrhea.

Abnormal changes in bones and joints

A crack or dislocation on the bone surface is called a fracture.

Rough and uneven bone surfaces are mostly due to bone degeneration or osteonecrosis.

The growth of spurs on bones or the formation of lumps of various shapes and sizes is called osteophyte proliferation.

The thinning of bones is called bone atrophy.

When bones, bony articular processes, or articular fossae only change their original shapes without the presence of proliferative growths, it is termed bone and joint deformation.

The condition where the head of a bone joint leaves the joint socket is called dislocation.

When the joint structure exists but its original positional relationship is altered, it is termed joint dislocation.

When the joint structure is stable and the joint position is normal, but normal extension and flexion movements cannot be performed, it is called tendon and vessel stiffness.

2. Why do tender points indicate the occurrence of wellness?

Tender reaction points are also known as wellness allergic reaction points, or “ashi points”, “tianying points”, and “tender points”.

Tender reaction points include deep tenderness and superficial tenderness. Superficial tenderness refers to the sensation of pain upon light stimulation of the superficial layer of the skin, indicating that the location of the wellness is relatively superficial and the condition is mild and easy to supports. Deep tenderness, on the other hand, requires relatively heavy pressing stimulation to elicit a tender reaction, suggesting that the location of the wellness is deeper and the condition is severe and difficult to supports. The ability to accurately locate tender points at the site of the lesion is of extremely important clinical significance for the assessment and supports of wellness. This is because identifying tender points is not only the best method for diagnosing wellness but also an important site for applying massage techniques in the supports of wellness.

Under normal circumstances, the meridians in the human body are interconnected, and blood flows unobstructed through the blood vessels in a continuous and endless cycle. When a certain part of the body is damaged, the meridians in that area are impaired, and blood flow is obstructed, causing the blood within the vessels to coagulate. This blocks the meridian pathways and helps maintain smooth blood flow. “Obstruction leads to pain,” thus resulting in wellness. This is analogous to how the flow of water in a ditch is obstructed by silt, sand, and stones, causing the water flow to slow down or become completely blocked. During palpation examination, cord-like subcutaneous nodules and tenderness reactions can be felt at the sites of blood coagulation. By applying corresponding tendon-regulating massage techniques at these locations, the stagnant blood can be dispersed, and the flow of qi and blood can be restored, thereby achieving the goal of supports the wellness.

Another example is that some visceral wellness may present with tenderness at the corresponding back-shu points and front-mu points of the viscera. Acute wellness often show tenderness at the back-shu points, while chronic wellness frequently present with tenderness at the front-mu points. For biliary wellness such as cholecystitis, tenderness can be found at the BL-19 (Danshu, Gall Bladder Shu) point and the gallbladder point. In cases of intra-abdominal inflammation, tenderness may occur at the RN-9 (Shuifen, Water Division) point, while for peptic ulcers, tenderness is often noted at the right ulcer point. In patients with piriformis syndrome, a cord-like hard mass with marked tenderness can be palpated deep within the gluteal muscles, and the pain may radiate to the affected lower limb. All these are effective methods for diagnosing wellness. Applying appropriate pressing and kneading techniques at these tender points can immediately helps with occasional the pain and achieve therapeutic effects.