In this blog post I would like to reflect on the importance of palpation in acupuncture & highlight this notion through a clinical snapshot of releasing the upper trapezius & occiput region in an individual who was experiencing a migraine headache.
Yesterday I was treating an individual at my Safety Beach (Mornington Peninsula) practice who presented to the acupuncture clinic with a main complaint of a continuous migraine. The duration of this particular bout of headache had been constant & intense for a good last 6-7 days prior to treatment. Various forms of self-medication (ibuprofen & other N.S.A.I.D’s) yielded little result and said minimal results were very short lived.
Upon examination the pulse exhibited a deep & weak movement in the foot taiyin position. Upon palpation the individual showed tight and contracted upper trapezius fibres in the region of left sided GB 12 Wangu to GB 20 Feng Chi down to GB 21 Jian Jing. The patient reported that her migraine was mainly on the left side of her head and reported that a pressure feeling ran from her temple to the outer canthus of her eye, with a numbness manifesting down the contour of her left jaw (gall bladder & stomach meridian).
Other palpatory findings (based on Kiiko Matsumoto’s Clinical Strategies) were slightly below Kid 16 Huang Shu (adrenal), Oketsu & Right Sided Shaoyang presentation (tight right sternocleidomastoid muscle).
Acupuncture treatment began by releasing the above mentioned reflective areas through utilising the spleen and kidney meridians. The sanjiao meridian (Si du) was coupled with the kidney meridian (Yingu) which subsequently released the region slightly below the right Kid 16 Haung Shu (adrenal), as well as right sided SCM & upper most region of the trapezius muscle (GB 12-20).
Needles were retained for 15 minutes with mild stimulation applied every 5 minutes with the final result being a near full release of above mentioned reflective areas, as well as a near complete release of the right side occiput region. The patient reported that ‘veil was lifting’ and once the treatment was completed (front & back) a significant reduction of the headache symptoms was reported by the individual.
Discussion:
I feel that the above example highlights the profound importance of utilising the art of palpation in both acupuncture diagnosis & treatment. As palpation provides a means in which ‘theory’ & ‘acupuncture point selection’ can be actively tested and crosschecked on the body in real time. Whilst utilising the subsequent amelioration of reflective areas/pulse or the individuals main symptom as the guide to gauge the relevance of the reached ‘diagnosis’ & treatment.
The application of palpation conducted in said manner creates a fluid ‘working’ diagnosis that merges with treatment & needling. The result being that the patient’s body is truly guiding treatment & the acupuncturist is merely interpreting, testing & implementing with the final word coming down to the patient in both objectivity & subjectivity.
A clinical example of the above paragraph is as follows:
Let us take the above case history of the individual with the migraine. Now, I stated that I needled Yingu Kid 10 & the reason for this was due to the fact that through directed palpation it was Yingu Kid 10 that did the best job at releasing the palpatory findings mentioned above. Thus theoretically (yet still based on palpation) I had decided that the kidney meridian should be used for this individual, my theory then brought me to split test Kid 6 Zhaohai, Kid 7 Fuliu & Kid 10. Through palpating these acupuncture points and correlating this to the relative release of pressure pain at said reflective areas. I & patient were able to gauge that Yingu Kid 10 released the most tightness and pressure pain. Thus this acupuncture point was needled.
So now you can see the clinical application of the statement “the patient’s body is truly guiding treatment” as I am “merely interpreting” the palpatory findings based on my theoretical understanding “testing” through applying finger pressure to chosen acupuncture points and evaluating their effect “& implementing” once the best effect is found I then needle the acupuncture point that yielded the best result. With of course the patient telling me whether they feel better or not.
Regardless of what ‘style’ of acupuncture a practitioner implements or devotes themselves to, I would greatly encourage the active ‘testing’ of theory directly on the body in some form or another, as this truly gives so much to patient & practitioner alike.
As always please feel free to contact me with any questions you may have.
Warm Regards,
Giancarlo Nerini – Acupuncturist (Melbourne)
Yesterday I was treating an individual at my Safety Beach (Mornington Peninsula) practice who presented to the acupuncture clinic with a main complaint of a continuous migraine. The duration of this particular bout of headache had been constant & intense for a good last 6-7 days prior to treatment. Various forms of self-medication (ibuprofen & other N.S.A.I.D’s) yielded little result and said minimal results were very short lived.
Upon examination the pulse exhibited a deep & weak movement in the foot taiyin position. Upon palpation the individual showed tight and contracted upper trapezius fibres in the region of left sided GB 12 Wangu to GB 20 Feng Chi down to GB 21 Jian Jing. The patient reported that her migraine was mainly on the left side of her head and reported that a pressure feeling ran from her temple to the outer canthus of her eye, with a numbness manifesting down the contour of her left jaw (gall bladder & stomach meridian).
Other palpatory findings (based on Kiiko Matsumoto’s Clinical Strategies) were slightly below Kid 16 Huang Shu (adrenal), Oketsu & Right Sided Shaoyang presentation (tight right sternocleidomastoid muscle).
Acupuncture treatment began by releasing the above mentioned reflective areas through utilising the spleen and kidney meridians. The sanjiao meridian (Si du) was coupled with the kidney meridian (Yingu) which subsequently released the region slightly below the right Kid 16 Haung Shu (adrenal), as well as right sided SCM & upper most region of the trapezius muscle (GB 12-20).
Needles were retained for 15 minutes with mild stimulation applied every 5 minutes with the final result being a near full release of above mentioned reflective areas, as well as a near complete release of the right side occiput region. The patient reported that ‘veil was lifting’ and once the treatment was completed (front & back) a significant reduction of the headache symptoms was reported by the individual.
Discussion:
I feel that the above example highlights the profound importance of utilising the art of palpation in both acupuncture diagnosis & treatment. As palpation provides a means in which ‘theory’ & ‘acupuncture point selection’ can be actively tested and crosschecked on the body in real time. Whilst utilising the subsequent amelioration of reflective areas/pulse or the individuals main symptom as the guide to gauge the relevance of the reached ‘diagnosis’ & treatment.
The application of palpation conducted in said manner creates a fluid ‘working’ diagnosis that merges with treatment & needling. The result being that the patient’s body is truly guiding treatment & the acupuncturist is merely interpreting, testing & implementing with the final word coming down to the patient in both objectivity & subjectivity.
A clinical example of the above paragraph is as follows:
Let us take the above case history of the individual with the migraine. Now, I stated that I needled Yingu Kid 10 & the reason for this was due to the fact that through directed palpation it was Yingu Kid 10 that did the best job at releasing the palpatory findings mentioned above. Thus theoretically (yet still based on palpation) I had decided that the kidney meridian should be used for this individual, my theory then brought me to split test Kid 6 Zhaohai, Kid 7 Fuliu & Kid 10. Through palpating these acupuncture points and correlating this to the relative release of pressure pain at said reflective areas. I & patient were able to gauge that Yingu Kid 10 released the most tightness and pressure pain. Thus this acupuncture point was needled.
So now you can see the clinical application of the statement “the patient’s body is truly guiding treatment” as I am “merely interpreting” the palpatory findings based on my theoretical understanding “testing” through applying finger pressure to chosen acupuncture points and evaluating their effect “& implementing” once the best effect is found I then needle the acupuncture point that yielded the best result. With of course the patient telling me whether they feel better or not.
Regardless of what ‘style’ of acupuncture a practitioner implements or devotes themselves to, I would greatly encourage the active ‘testing’ of theory directly on the body in some form or another, as this truly gives so much to patient & practitioner alike.
As always please feel free to contact me with any questions you may have.
Warm Regards,
Giancarlo Nerini – Acupuncturist (Melbourne)
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