2 Pressing the chest and abdomen
1.4.2.2,1 Pressing the chest
Pressing the chest is helpful for detecting the pathological changes of the heart, the lung and the precordium.
Bulgy chest with clear noise when tapped is seen in pneumatothorax. Pain of the chest under pressure and with dull noise when tapped is often seen in retention of fluid in the chest and diaphragm or accumulation of phlegmatic heat in the lung.
Precordium, located between the fourth and fifth ribs, below the nipple and slightly medial to the nipple, is the pulsation point of the apex of the heart where all the vessels converge. Pressing the precordium is helpful for detecting whether the thoracic qi is strong or weak, whether the disease is asthenic or sthenic and whether the prognosis is favourable or unfavourable. The pressing of precordium is especially useful when cunkou pulse is difficult to take in critical cases. Normally, the pulsation over the precordium is sensible and beating smoothly, moderately and rhythmically, indicating exuberance of heart qi, accumulation of thoracic qi in the chest and no signs of pathological changes. Weak and indistinct pulsation over the precordium suggests asthenia of the thoracic qi. Powerful pulsation over the precordium vibrating the clothes is hyperactivity of precordial beating, a sign of outburst of the thoracic qi.
1.4.2.2.2 Pressing the hypochondrium
Pressing hypochondrium is helpful for detecting diseases related to the liver and gallbladder.
Distending pain of hypochondrium with sensible lumps below the sternum and evident tenderness is usually due to stagnation of liver qi and gallbladder qi or due to damp heat in the liver and gallbladder. Hypochondriac lumps with stabbing and unpalpable pain is often caused by depression of liver qi and blood stasis. Right hypochondriac lumps which is hard and uneven are due to accumulation of mass resulting from prolonged stagnation of qi or blood stasis, and cares should be taken to exclude liver cancer. Repeated relapse of malaria with hard and palpable lumps
is called malaria with abdominal mass.
1.4.2.2.3 Pressing epigastrium and abdomen
Pressing epigastrium and abdomen is helpful for detecting the disorders of the stomach, spleen, small intestine, large intestine, bladder and uterus, etc.
Generally speaking, cold sensation of the skin when pressed with preference for warmth is usually of cold syndrome; feverish sensation of the skin when pressed with preference for cold is of heat syndrome; epigastric and abdominal pain with preference for pressure is of asthenia syndrome; and epigastric and abdominal pain with aversion to pressure is of sthenia syndrome.
Epigastric fullness with soft sensation and no pain when pressed is caused by weakness of the stomach; epigastric fullness with hard and painful sensation when
pressed usually results from accumulation of sthenic pathogenic factors in the epigastrium. Distending epigastric pain with hard sensation and gurgling noise when pressed is due to retention of fluid in the stomach resulting from
asthenia of the middle energizer qi and stagnation of qi.
Full sensation of the abdomen under pressure with tenderness is known as sthenic fullness due to qi stagnation, blood stasis or retention of fluid; soft sensation of the abdomen under pressure and without tenderness is known as asthenic fullness due to asthenia of yangqi or failure of transportation caused by qi asthenia.
Drum-like swelling of the abdomen with dull yellowish skin, visible veins over the abdominal wall and emaciation of the four limbs is called tympanites.Tympanites with fluid sensation when pressed and dull sound when tapped is called hydraulic tympanites; while tympanites with empty sensation when tapped is known as pneumo tympanites.
Immobile abdominal lumps with fixed pain is unmovable mass due to blood stasis; mobile abdominal lumps with migratory pain is known as movable mass due to qi stagnation.
Unpalpable pain in right lower abdomen, with mass when pressing, is often seen in the intestinal abscess and so on .
