Tuinaology I - TCM 235

Total Student Learning Time (SLT) (L = Lecture; T = Tutorial; P = Practical;

O=
Others):
Independent Learning
Total Student Learning Time
Face to Face
(hr)
(hr)
L
T
P
O
21
8
20
4.5
66.5
120

TOPIC 1: NTRODUCTION
The therapeutic effects of Tuina:
Tuina is derived from the Chinese words Tui to push and Na to grasp, two techniques
fundamental to traditional Chinese medical massage and manipulation. In present day China,
Traditional Chinese Medicine (TCM) is main stream, existing alongside Western medicine and
providing for many of the health needs of its massive 1.3 billion plus population.
Like acupuncture, Tuina is based on classical Chinese medical theory. This places its emphasis on
function and wholeness. A body is regarded as complete and therefore healthy if the various intrinsic
energies (called Qi pronounced chee) are correctly balanced within it at any particular point in
time. Even the slightest interruption to the diffusion and flow of qi will manifest itself as illness and
pain.
According to the Chinese, the body contains a grid system which contains and controls the movement
of qi. Some 2,500 years ago there already existed bronze figures with twelve paired channels or
meridians and two unpaired ones embossed on their surfaces. Even at that early date the Chinese had
discovered this grid-system and had accurately plotted not only the exact positions of each meridian but
also the precise positions of over 300 acupoints or qi-points along them.
Tui Na treats chronic pain, especially that caused by muscle-skeletal conditions and injuries. Neck,
shoulder and back pain and immobility, sciatica and 'tennis elbow' all respond very well.
It is, however, impossible to treat a specific condition with Tui Na without improving the overall Qi
status of the body.
This means that headaches, migraines, IBS, constipation, PMS and a whole range of emotional
problems can also be treated

The therapeutic principles of Tuina:

Tuina is carried out on the clothed body with the recipient seated or lying on a massage couch. The
Chinese describe all techniques as manipulations but the author restricts this description to those that
work with movable joints. Others that treat soft tissues are referred to as massage techniques
although many differ widely from those used in the likes of Swedish and aromatherapy massage.
The aim of Tuina is to apply movement and pressure to facilitate the flow of qi through the meridian
channels and to regulate this with deep stimulation of relevant qi-points. Tuina is not acupressure. The
latter is exactly what it says it is, namely deep, static pressure applied to qi-points. Tuina on the other
hand, offers the practitioner a diverse range of techniques that are designed to focus pressure with
movement both along the meridians and into the qi-points. The subtle variety of direction and force that
can be brought to bear on each point is one of the unique features of this massage.
For Tuina to be successful in facilitating qi flow and releasing blockages in this vital energy, the tissues
themselves must be amenable to the diffusion of qi. The soft tissue techniques achieve this by loosening
the muscle fasciae (connective tissue sheaths enclosing muscle), stimulating lymph flow and blood
circulation and affecting tendon organs (tension sensitive sense organs in tendons) so as to improve
muscle relaxation.
Every qi-point has an effect on qi movement when it is intensely stimulated with pressure or a needle as
in acupuncture. An expert Tuina practitioner will know what combination of these points to use when
treating specific problems such as frozen shoulders, sciatica, nausea etc.
Whilst it is true to say that most qi-points can be used to treat problems in their immediate vicinity,
many have powerful effects in quite distant parts of the body. For example, qi-point pericardium 6 on
the underside of the forearm just up from the wrist has a powerful calming effect and stops vomiting.
Qi-point large intestine 4 between first and second metacarpels treats headaches and sinus problems
and bladder 60 behind the outer ankle bone (maleolus) treats lower back pain. This means Tuina can
treat problems in places where the therapists hands cannot reach.
Tui Na works in accordance with the complex theory of TCM. Fundamental to this theory is the life
powering energy that the Chinese call Qi (pronounced 'chee'). Every aspect of bodily function depends
upon Qi and its flow through the tissues.

The Chinese recognise a network of 12 paired meridians - one member of each pair on the right side of
the body and the other on the left. There are also two unpaired meridians that encircle the trunk and the
head in the mid-line.
These meridians are not like vessels, they have no anatomical structure but they are pathways along
which the main flow of Qi occurs. It is best to visualise them as precise currents of Qi, just like currents
of water in the oceans.
Interestingly, Western scientific methods have been used to plot the courses of these meridians, and
they confirm the accuracy of detailed maps produced around the time of The Yellow Emperor's Classics
of Internal Medicine.
At irregular intervals along the meridians there are specific Qi points (the acu-points of acupuncture)
where pressure, needles or heat can affect the way Qi flows through the meridian. This effect can
manifest itself on some part of the meridian quite distant from where the stimulus is applied.
When Qi flow is disturbed anywhere in the body, Qi imbalance that results can cause pain, stiffness,
sickness - even emotional pain. The Chinese believe that health and vitality depend on Qi balance in the
body. Tui Na is one of the best ways of achieving this and it uses an array of techniques to do it.
A Casual observer watching a session sees what appears to be a thorough workout for the soft tissues
and joints, but the practitioner aims to do more than this. Attention is focused on meridians and selected
Qi points. They are massaged in different ways to remove all blockages to the flow of Qi. In China, Tui
Na is used for conditions that, in the West, would be treated by osteopaths, chiropractors and
physiotherapists or with drugs.
The prescriptions for choosing acupoints, the classification of special acupoints and the special
acupoints in common use.
Tuina incorporates a wide variety of massage techniques traditionally used in China and is now
spreading across the world. Tuina is a professional branch of Chinese medicine which uses hand
manipulations (massage) for therapeutic reasons.

The hand techniques utilize a variety of principles in their application to specific disorders. They can be
divided into several categories of therapeutic effect. These categories include oscillating methods,
pressure methods, passive joint movement, pinching or plucking methods, and Qi emitting methods.

Oscillating Methods rely on the development of a kinesthetic wave pattern through repetitive
movement. This movement generates a rhythmic wave pattern that penetrates deeply into the
body and activates the circulation of Qi and blood. This wave also effects the nervous system.
Pressure is a secondary aspect of this principle

Pressure Techniques rely on the use of force to develop either a static pressure, an alternating
pressure, or a release/moving pressure. These techniques are used to facilitate the removal of
obstruction, relieve Qi and blood stagnation, and harmonize the flow of Qi and blood.

Passive Joint Movement features the use of range of motion to help restore functional anatomy
and re-educate the nervous system. It also helps relieve Qi and blood stagnation.

Pinching or Plucking Techniques are applied to the skin, tendons, or muscles. These techniques
feature pulling and lifting either quickly or moderately to effect the tonus of the skin, tendons, or
muscles to increase range of motion of joints.

Qi Emitting Methods utilize light to moderate pressure on acupoints and the concentration and
extension of Qi through the palm or fingers of the practitioner. This can be combines with specific
breathing patterns and pressure combinations. The intention is to active the flow of Qi through a
specific acupoints or channel. The direction of Qi movement can also be affected by either
pushing or pulling with the Qi.

The goals of the hand techniques are to disperse, tonify, activate, harmonize, and warm the Qi and
blood. These goals are achieved by varying rate, pressure, and duration of a Tuina treatment. The
combination of Qi extension with the specific hand techniques produces a more pronounced
effect.

The common manipulation and acupoints of paediatric Tuina:

The following techniques are used to perform pediatric tuina massage. Unlike Swedish style massage
where muscles are mostly kneaded, youll be stroking, pushing, pulling, and pressing various points on
the body. To be effective, these movements should be gentle yet firm with even rhythmic movements.
Most manipulations will be performed anywhere from 50 to 300 times in rapid succession. I have found
it easier to time the massage on certain points than to count how many strokes Ive used.
For mild illness, massages should be performed once a day and for more severe or acute illness such as
flu, fever, or cough, massages should be performed 2 3 times per day. Youll need to teach parents the
prescribed massage so they can do it at home.

Straight Pushing (zhi tui fa)

Push your thumb, or index and middle fingers, in a straight line. This is often used on the forearm,

fingers, and back.

Pushing Apart (fen tui fa)
Starting with your thumbs at a single location, push them apart. This is often used on the forehead

and chest.
Kneading (rou fa)
Press one or two fingers on a point or area, rotate them in a circular motion without lifting the
skin. Kneading can also be applied with three fingers, the palm of the hand, the thenar emminence

(the fatty pad below your thumb), or your thumb.

Circular Rubbing (mo fa)
Rub the abdomen in a circular motion with four fingers or the palm of your hand. It is most

commonly used for abdominal pain, constipation, or diarrhea.

Pinching and Pulling (nie fa)
This technique is commonly used on the paraspinal muscles, (the muscles next to the
spine). Always start at the base of the spine and move upward in a straight line progressing up to
the neck. Grab a small amount of muscle tissue and pinch it up between your index finger and
thumb with a firm but gentle pressure. Then, continue to roll your thumbs forward as you release
and grab more muscle tissue. Be sure to use plenty of talcum powder so you dont cause any
chafing. This technique is used for general wellness, the common cold and respiratory conditions.

Pressing (an fa)

Press a point or area and hold for a few seconds 3 5 times in a row to help relieve pain and

discomfort. This is usually done with the thumb or the palm of the hand.
Nipping (qia fa)
Stimulate specific points with gentle pressure from your thumbnail. It doesnt take much pressure

for the point to be adequately stimulated, so be careful not to press too hard.
Arc/Circle Pushing (yun fa)
Use your thumb to make a circle with gentle, but firm pressure. This technique is most commonly
used on the palm of the hand.