3 Palpation of the four limbs
1.4.2.3.1 Detection of cold and heat
Feeling of cold and heat of the hands and feet is helpful for judging the states of diseases, such as cold and heat, asthenia and sthenia, internal and external
aspects as well as favourable and unfavourable prognosis.
Generally speaking, cold sensation of hands and feet is usually of cold syndrome due to asthenia of yang and exuberance of cold; feverish sensation of hands and feet is often of heat syndrome due to predomination of yang and exuberance of heat. However, sometimes pathogenic heat deepens into the body and prevents yang from moving outward, leading to internal heat syndrome known as ˇ°deep heat and deep syncopeˇ±, a critical sign of disease.
If the palms and soles are more feverish than the dorsa of hands and feet, it suggests fever due to internal impairment. If the forehead is more feverish than the palms, it is superficial fever. If the palms are more feverish than the forehead, it suggests internal heat.
1.4.2.3.2 Palpating the skin from inner side of the elbow to the transverse lines on the wrist
It is helpful for judging the nature of disease according to its conditions of being tense or loose, slippery or astringent and cold or feverish.
If the skin is very feverish and the pulse is full, slippery, fast and powerful, it usually suggests fever in exogenous febrile disease; if the skin is cold and the pulse is thin and small, it indicates diarrhea and insufficiency of qi due to asthenia of yangqi and predomination of internal cold; if the skin is lubricant, it shows sufficiency of qi and blood; if the skin is as rough as scales of dry fish, it
suggests insufficiency of essence and blood or phlegm and fluid disorder due to failure of the spleen to transform fluid resulting from decline of splenic yang.
1.4.2.3.3 Palpation of swelling and distension
Heavy pressure on swollen and distending skin with hands is helpful for differentiating edema and flatulence. If the fingers sink into the skin when the skin is pressed and the depression on the skin fails to rebound when the fingers are lifted, it is edema; if the depression on the skin produced by pressure rebounds when the fingers are lifted, it is flatulence.
