1. Palpation Techniques in case examples 1
PALPATION TECHNIQUES in case examples
What follows are a few examples of how I use the palpation techniques we’ve been working with in
my own practice. These examples are not meant to be complete case records per se and the fact
that patients all improved as a result of treatment they received is not really the point. Their
primary purpose of is to illustrate some aspect of my approach to palpation and treatment.
Using this approach to palpation we’re listening for what the patient’s qi is trying to tell us and
we’re trying not to get caught up in what we think we should be doing. That means it won’t always
be appropriate to be trying to listen and work in terms of the extraordinary vessels, or the fluids or
the CRI. Sometimes one or more of these forms of listening will be more prevalent or more relevant
than others. The examples reflect this. In all these cases, points were picked using manual thermal
diagnosis and channel listening etc. and my overall operating procedure was consistent with the
way we worked in the practice sets.
Case 1 illustrates the application of many of the palpatory sensibilities we’ve discussed including EV
morphology.
Case 2 illustrates the use of the sacral tilt listening method in the very simple treatment of back and
lower extremity pain. Is that any of these techniques can potentially be integrated into whatever
style one is already practicing.
Case 3 focuses on the phenomena of ignition, and the profound shifts that Settling Slowing,
Integrating and Opening (SSIO) can facilitate in even very sick individuals.
Case 4 illustrates the use of a listening technique that we have not yet discussed but will explore in
some depth in the Level II class in October 2012. For now, a brief description will suffice.
General Listening Techniques
Most of the listening techniques in osteopathy require a fair amount of anatomical knowledge. A
number of these can be immensely helpful for acupuncturist in that they can provide information as
to the location of the primary problem much in the same way that the CRI listening posts do, though
potentially with much greater precision.
The technique can be conceptualized as a refinement of the sacral palpation that you learned from
Dan. It involves feeling for the primary strain patterns at work in the system. Although sometimes
rather subtle, it is in fact a structural or mechanical form of listening as opposed to an energetic
one.
With the patient standing with their eyes closed, one places one’s hand on the top of the patient’s
head and applies gentle pressure. One is drawn to the area of greatest restriction within the body.
This, by definition is the most problematic area. The finding may be very general, for instance,
upper right quadrant, or very specific, such as the middle lobe of the right lung. or even the
common bile duct.. The procedure is repeated with the patient sitting which eliminates any
feedback from the lower extremities that may be confounding the findings. The patient is then
instructed lie supine. One places one’s hand on the abdomen in the epigastric region and applies
pressure adequate to come into conversation with the viscera. One’s hand is again drawn to the
area of greatest restriction, and like the sacral listening technique on can move one’s hand to hone
in on the restriction. Using this technique, it is possible to glean very specific information regarding
visceral problems.
© Charles Chace 2012.
This material can be use for educational purposes only.

2. Palpation Techniques in case examples 2
Case 1:
Head injury
Example of work with: EV Morphology, CRI Listening Posts.
26 yo female.
Complaint & Main Symptoms:
Cognitive impairment subsequent to head injury in auto accident 1 year previously
Visual impairment:
difficult to focus / convergence issues
Vision in right eye was suppressed
Eyes focus at different distances.
Peripheral vision poor .
Intense vertigo and balance problems: Feels like at sea
Occipital pain and burning pain in scalp and pain in arms since accident: Pain pretty well until
a few weeks ago.
Insomnia
Profound fatigue
Epilepsy since age 3. Med: phenobarbitol until age 17. No seizures since march 2003
Tinnitus and hyperacusis since accident
Longstanding mitral valve prolapse, accompanied by intermittent PVCs
Exam:
Tongue: scalloped pale, thin coat. red tip. SLV at base.
General Listening:
SOQ: sinking and imploded.
CRI barely perceptible.
Pulse: Faint, Ki sho (left chi and right cun positions weakest)
Acupuncture Diagnosis
Trauma damaging the Essence Qi on the level of the Chong Mai
© Charles Chace 2012.
This material can be use for educational purposes only.

3. Palpation Techniques in case examples 3
Treatment
Step Points treated Outcome
Step 1 Ki 3, Lu 6, Liv 3, Pulse balances, tongue color improves
(contact needle.) CRI is amplified
Listening posts to pelvis and chest.
SOQ homogenizes and rises and balances.
Fluid tide thin but palpable
Step 2 St 30, CV 17 Pulse strengthens and becomes more supple
balances.
CRI listening posts equalize and amplify.
Fluid tide more robust and more fluid overall
Step 3 Naso/sanshin on neck Ignition
Direct Moxa CV 6
2nd Visit: 2 weeks later
Symptom’s follow up:
Sleep improved since tx
Dizziness much improved, barely noticeable
Now practicing yoga.
No Change in Pain in arms
Frontal /visual H/A this week
Exam:
General Listening:
SOQ: sinking and imploded.
CRI nominally more robust.
Pulse: fine Ki sho (left chi and right cun positions weakest)
© Charles Chace 2012.
This material can be use for educational purposes only.

4. Palpation Techniques in case examples 4
Treatment
Step Points treated Outcome
Step 1 Ki 8, Lu 7, Liv 3 Pulse CRI and SOQ improve
(contact needle.) CRI listenting posts to left ankle
Morhpology: Listening to Yinqiao ­­yinwei
Step 2 Ki 2, P 6, CV 23 All palpatory findings improve.
Ignition
Step 3 Sanshin neck and chest Further smoothing and integrating .
3rd Visit: 1 week later.
Symptom’s follow up:
Again better after last tx
Overal pain significantly diminished,
Fewer headaches.
Dizziness barely noticeable
Exam:
General Listening:
to the Lower Left Quadrant, EV morphology to Yangqiao
Pulse Rt cun deviated (LI channel)
Sp Ki Xu
Treatment
Step Points treated Outcome
Step 1 Sp 3, Ki 10 Pulse CRI and SOQ improve
(contact needle.) CRI listenting posts to left ankle
Step 2 LI 10 All palpatory findings improve. Yangqio remains
Step 3 Naso Further smoothing and integrating
Step 4 Bl 62, GB 20 Dynamic stillness. EV Pulse gone
The patient received acupuncture using this approach every 2‐3 weeks for the next few months,
during which time the complications of her head injury continued to improve.
© Charles Chace 2012.
This material can be use for educational purposes only.

5. Palpation Techniques in case examples 5
Case 2:
Back pain subsequent to surgery to remove bone spurs on right foot.
Example of work with: Sacral tilt. Freedom in the protocol’s use
Complaint & Main Symptoms:
Back pain subsequent to surgery to remove bone spurs on right foot , currently working on
post surgical rehab.
Has returned to exercise‐ climbing.
Exhausted w/ activity around foot.
Surgical screws making area red and angry.
Sacral, coccygeal pain accompanied by pain radiating into buttock ‐ w/ some neurological pain.
Overheating, no sweating or flushing.
Mentally – unrested.
Exam
General Listening:
Sacral Tilt to the left.
Occiputal tilt to the right.
CRI listening posts to left knee
Treatment
Step Points treated Outcome
Step 1 Left Bl 57 Right GB 20 and Sacral tilt neutralizes.
GB 21 (needles retained)
Step 2 Cuping, one cup on either side SSIO
of sacrum
Follow­up 4 days later: back pain much improved.
© Charles Chace 2012.
This material can be use for educational purposes only.

6. Palpation Techniques in case examples 6
Case 3:
Rheumatoid Lung
Example of work with: Ignition
Male 75yo
Initial visit in Nov. , 2008
Complaint & Main Symptoms:
Diagnosed with Rheumatoid Arthritis afflicting the Lungs in 1990
Persistent cough (every 15‐45 minutes) since 2006
Dx; Congestive Heart Failure 2007
Chronic Sinus Infections
Chronic Bronchitis, sputum culture shows 4 different strains of Bacteria.
Currently: FEV 18%
Exam
Tongue: Red‐purple, Clean
General Listening:
SOQ: Floating. Overall sense of an absence of vitality
Ascultation: diminished lung sounds, weak inspiratory and expiratory crackles.
Pulse: Strong, choppy, bound and rapid
Abdomen. Uniformly Deficient.
Diagnosis:
(phlegm) stasis and congestive heat in the chest overlying Kidney essence Xu.
© Charles Chace 2012.
This material can be use for educational purposes only.

7. Palpation Techniques in case examples 7
Treatment
This patient was obviously quite sick and suffered from a number of degenerative disease
processes that had become more active over the preceding year. He told me on a number of
occasions that he’d become quite used to life threatening illnesses, and confounding his doctors
who were at something of a loss to explain why he was still alive. At the time we began working
together, he was ambulatory although his pulmonary function had deteriorated to a point where his
long term prognosis had become quite poor.
I treated him for two months using a variety of acupuncture approaches and Chinese herbs to no
avail and his condition continued to deteriorate. He seemed to have no qi to work with, and there
were a number of patterns competing for attention. I decided to simplify my acupuncture approach
and focus on engaging his primal qi.
Step Points treated Outcome
Step 1 Lu 6, Ki 10, BL 1 Pulse softens and smoothes out
(contact needle) SSIO
Amplitude of CRI improves incrementally
EV Listening to Chong/Ren
Step 2 CV 17, CV 6
Needles retained
With those needles retained, I sat down and held his feet grounding myself in the
manner now familiar to us all.
The patient sank and settled in the usual manner, but stuck with him for another
15 minutes or so, with my hands on his feet, just doing the SSI within myself.
During this time everything he seemed to reach a deeper level of quiescence.
To the extent I was looking for anything, I was trying to create the conditions for a
long tide, but that didn’t happen. Instead, we got an ignition, a systemic deqi
arising from everywhere within the patient at once that just kept on coming. His qi
filled out beautifully and the vigor and amplitude of his CRI increased
dramatically. His pulse softened and slowed. After another few minutes I got up
and left the room.
One of my students who had been in the room at the time said “what was that?”
She had felt the phenomena from across the room. Curiously, the patient had felt
nothing.
This proved to be a turning point in the arc of the patient’s recovery.
When he returned two weeks later he reported that his pulmonary function was
now 20% , a small but significant improvement. He felt better overall and he was
coughing significantly less. Over the next few months his lung function gradually
improved to 24%, far from healthy, but well out of the danger zone.
© Charles Chace 2012.
This material can be use for educational purposes only.

8. Palpation Techniques in case examples 8
Case 4:
Nausea, Persistent headache, Paresthesias and generalized pain
associated with Multiple Sclerosis
Example of work with: EV Morphology, CRI Listening Posts, midline, ignition.
Freedom in the protocol’s use
Complaint & Main Symptoms:
Multiple Sclerosis diagnosed: November 2010
CC:
Nausea,
Persistent migraine.
paresthesais and generalized pain,
visual disturbances, associated with Multiple Sclerosis
Since initial attack 14 mo. previously, had a persistent Left Temporal Parietal H/A like having been
hit in the head .
Generalized pain 3‐4/10
In past two days as completely weaned from the following meds.
Neurontin Seizures
Ritalin Fatigue
Baclifin Spasticity
Pain (caused seizures? )
Traumadol
Has now disc
Lorazapan Helps w/ sleep disorder caused by wellbutrin
Prednisone as needed: 50mg pd
Current Meds:
Wellbutrin prescribed for pain (patient denies any anxiety or depression)
Copaxone Daily IM injection for MS
© Charles Chace 2012.
This material can be use for educational purposes only.

9. Palpation Techniques in case examples 9
Exam
Tongue: Normal
General Listening:
Anterior Medulla
T3 L/2‐3
(Patient subsequently reports that his Ms lesions are in the back of his brain and upper spine,
Arthritis in Lumbar spine)
SOQ: Flat
CRI: unremarkable
Pulse: scattered, especially faint in bilat chi positions. Unclear
Abdomen robust, slightly soft on right subcostal region @ GB 24
Treatment
Step Points treated Outcome
Step 1 CV­9 Clarifies the pulse; Treat for Liver Sho
(contact needle)
Step 2 Ki 2, Liv 3, Bl 1 Pulse improves, SSOI
(contact needle) Listening to Lower spine remains
Midline scattered
Step 3 San shin spine focusing on T‐3 Midline becoming coherent, increased density at
L 3 mid thorax
Ren? Du
Step 4 CV 15, T2, GB 43 Midline becomes quiet open and coherent.
Headache resolves
Step 5 Facilitate fluid tide through Qi feels balanced and open but still not much of it.
the cranium Still flat.
Step 6 EV4 needle technique at CV 4 Enhanced quality of vitality and openness
to facilitate an ignition. Final pulse check: pulse is balanced.
(this technique will be
presented in the Level II class
in Oct.)
© Charles Chace 2012.
This material can be use for educational purposes only.