Chinese Tuina Study
1. Introduction of Chinese Massage History
Chinese massage has a long history and dates back to the ancient times. Archaeological studies in recent years have found that as early as the late period of the New Stone Age (around 2,700 B.C.), Chinese ancestors in the Yellow River valley began to summarize the initial experience in massage gradually accumulated by their forefathers in their struggle for life. This transformed the spontaneous medical treatment that originated from self -security instinct into a primeval medical application for the health of early human race.
It was recorded in one ancient book that a famous doctor in the reign of Emperor Huang called Xu Fu used the ancient massage technique "anwu" in his clinical practice.
At the time of the Shang Dynasty, primitive witch doctors were very popular. They were socially prestigious, dominant in administering incantation, praying, fortune telling and the medicine affairs. They often used folk arts including massage to show their miraculous power for the religious and superstitious purposes. That is why the witch officials were also called "miraculous doctors." It was recorded in the unearthed oracle inscriptions on bones or tortoise shells of the Shang Dynasty that the female witch doctor Bi could treat the patients with massage-like skills. This testifies that massage technique of that time had reached quite a high level.
In the time of the Spring and Autumn and Warring States, owing to the collapse of slavery system, the idealistic concept of religious authority began to be in a shake while the simple materialistic theory of yin and yang were developed. Those witch doctors of the old days emerged from the people and gradually became doctors mastering practical medical skills. This social change promoted the development of ancient medicine.
Take medical terminology for example, the treatment with hand pressing, kneading and stroking was then called massage, the treatment of making the patients relax and extend their hands and feet and breath in prone or supine position was called leading (pressing) or stepping while the combination of the two manipulations was called pressing and stepping or stepping and rubbing. In practice, the forms of manipulation gradually reach their perfection, with its application range obviously expanded and its therapeutic effect enhanced.
Bian Que, a famous doctor at the time, was an example in practicing massage and acupuncture as a comprehensive treatment. He got crown prince Guo's syncope cured with a miraculous effect of bringing the dead back to life. In addition, records of the folk use of massage therapy can be found in many unauthoritive medical writings of the time such as Lao Zi, Meng Zi, Xun Zi and Mo Zi.
Up to the dynasties of Qin, Han and the Three Kingdoms, Chinese people came to sum up the experience that had been accumulated and recorded improvement in the methods that had been invented in the earlier times, contributing greatly to the publication of the first medical book on massage--not only in the history of China and but also in the history of the world--ten volumes of Classics on Massare of Yellow Emperor and Qi Bo.
Unfortunately, this book was lost. Yet, it is quite lucky that another great medical book The Yellow Emperor's Internal Classic published in the same period with many chapters concerning massage. This book is comprehensive in massage subject, covering such fields as the massage origination, manipulation methods, clinical application, indications, therapeutic principles and so on. For example, in terms of massage manipulation, a dozen manipulation methods such as pushing, pressing, rubbing, stepping and pulling are mentioned in this book and in regard of indications, acute and chronic diseases such as dreadfulness, syncope with flacidity, cold and heat, spleen-wind, blockage of channels, abdominal pain due to cold, etc. are listed in detail. Incisive expositions were made in the book especially on mechanism of manipulation therapy and some of them are still guiding today's clinical practice.
Later, Zhang Zhongjing, a medical saint of the Eastern Han Dynasty, mentioned and recorded for the first time the "gaomo" treatment in his book Treatise on Febrile and Miscellaneous Diseases. Using such methods practitioners should prepare some ointment in advance and smear it on a certain part of the skin. Then manipulations of stroking, rubbing, scrubbing and kneading should be administered on this part to achieve a combined effect of massage and medicine. This not only can enhance the therapeutic effect, but also extend the application range of massage. The famous doctor Hua Tuo of Three-Kingdom Period was especially good at treating febrile diseases and removing superficial pathogen from the skin with gaomo therapy.
2. Mechnism of Chinese Massage
Massage is a Chinese medical therapy with various manipulations applied to certain parts of the human body (including specified passive movement of the limbs) to prevent diseases. One factor is the quality of the manipulation and the other factor is the exceptional effect of the manipulated locations, channels and collaterals, and points. Therefore, generally speaking, when the curative effect of massage is working upon one specified location of the body through manipulations, the direct effect of its stress can act locally to promote blood circulation and remove blood stasis, restore and treat injured soft tissues, correct deformity and abnormal location of bones and soft tissues in anatomic site. On the other hand, dynamic wave signals of the manipulation can reflexively influence the physiological function and pathological state of the body fluid, Qi and blood, ying, wei, cerebrospine, viscera, mind and emotion, etc. through the conducting channels points and collaterals viscera so as to effect a recuperative medical function over other part of the body or whole body. The main acting principles are as follows:
2 -1. Regulating Yin and Yang
Yin and yang are a pair of concepts in the ancient Chinese philosophy, representing respectively one part of a thing "exposed to the sun", and the remaining part "facing the opposite direction of the sun, " the former being yang and the latter yin. Later, this concept was extended to explain any two opposite sides or phenomena that nourish each other, supplement each other or wane and wax mutually (one wanes, the other waxes or vice versa) and transform to each other, which gradually developed into yin-yang theory. As early as more than two thousand years ago, yin-yang theory was introduced into TCM and became an important part of its basic theory, explaining the organic structure, the physiological function and the pathologic change of the human body and guiding clinical diagnosis and treatment.
According to yin-yang theory, every part of the human body is consisted of two opposite but unified materials or functions, i.e. yin and yang. So far as the structure of the human body is concerned, the exterior is yang whereas the interior is yin; the upper part is yang and the lower part is yin; the back is yang and the abdomen yin. So far as the zang and fu organs are concerned, the six fu-organs are yang and the five zang-organs yin. So far as Qi and blood are concerned, Qi is yang and blood yin. In terms of function and material, function is yang and material yin. In terms of functioning status, excitement is yang and depression yin; activity is yang and stasis yin; growth is yang and decline yin.
As for the functional activity of Qi, upward is yang and downward yin; outward is yang while inward yin, etc. If yin and yang are in dynamic equilibrium, life activity will remain in a healthy state of balance But if the balance of yin and yang is broken due to the six pathogenic factors, seven emotions or traumatic injuries and so on, there can be such pathogenic changes as an excess of yang causing heat syndrome and an excess of yin cold one; an excess of yin leading to disorder of yang, excess of yang disorder of yin; insufficiency of yang causing exterior cold syndrome, deficiency of yin interior heat one, etc. Clinical syndromes inclined to yin, yang, exterior, interior, cold, heat, deficiency, excess of different degrees and properties may be present.
Massage treatment follows the principle described in The Yellow Emperor's Internal Classic as "examining carefully the status of yin and yang so as to get them in balance.” That is to say, massagists should, according to different diagnosis results, use different manipulations which may be mild, powerful, slow, quick, vigorous or soft in order to treat the illness, of deficiency type by using tonifying methods, excess syndromes with the purgative and reductive manipulation, heat syndromes with methods of cold or cool nature, cold syndromes with hot-natured methods, stasis by dissipation, stagnation and accumulation of pathogen by diffusion methods, exopathogens in the superficies of the body by dispersion, and half exterior and half interior syndromes by mediation, thus changing the relative excessiveness of yin and yang, regulating their relationship and restoring their balance, eliminating pathogen and recovering the vital-Qi.
The deficiency of yin, deficiency of yang or deficiency of both yin and yang of the corresponding viscera can be rectified when using light, soft and slow pushing with one-finger meditation, or using kneading and rubbing therapies by stimulating the specified Front-Mu points, Shu points and other adjunct points. The relatively strong or powerful manipulations such as rubbing, scrubbing or squeezing and pressing therapies can expel pathogenic factors and reduce excessiveness.
For the diseases of cold, deficiency and yin types, relatively slow and soft rhythmical manipulations can be used for comparatively a longer time to make the patients feel warmth and heat, to promote Qi circulation by warming yang. Furthermore, scrubbing mildly at the waist can nourish yin, remove fire, clear away deficiency heat from the blood. Pushing mildly of Du channel from Dazhui to sacrum or coccyx can clear away excessive heat from Qi system while pushing forcefully along the same route can cool the blood and clear away excessive heat from the blood system.
In TCM, soft tissues and joints include fascia, muscle, muscle tendon, tendon sheath, ligament, joint capsule, synovium, fibrous ring of verterbral disc, articular cartilage disc and other soft tissues of the body. Any direct trauma, indirect trauma and long-term strain can bring a series of pathogenic changes. Their injuries can be local bruise, muscle sprain, fibrous rupture, tendon avulsion, slipped tendon, ligament rupture, laceration of joint capsule, semi-dislocation of bones, joint dislocation, chondroclasis and joint or soft tissue strain, and so on. Massage has quite a good curative effect on all the above-mentioned illnesses, and its functioning principles are as follows:
2-2. Relax muscles and tendons and dredge the channels and collaterals
When there is trauma, signals of spasm and pain can be sent off by the attaching points of muscles, fasciae, tendon, joint capsules, etc. to alert the concerned tissues through the reflexion of the nerve. Muscular contraction, tension and even spasm are the very reflexion of this alert status. This is a protective reaction of human body, aiming at reducing the activities of the limbs and avoiding the tracting stimulation to the injured part so as to relieve pain. But if no timely treatment is given or the treatment is not thorough-going, adhesion, fibrosis or cicatrization of the injured tissues will occur and even damaging impulsion will be produced to increase the pain, muscular contraction or tension, and subsequently secondary pain foci and malignant pain rings will appear in the surrounding tissues. Both the primary and secondary foci can stimulate and compress the terminals of nerves and the small nutrient blood vessels, resulting in partial obstruction in blood circulation and metabolism.
Massage is a very effective way to remove muscular tension and spasm, in which it can not only relax the muscles but also get rid of the cause that leads to the muscular tension. The mechanism of massage is consisted of three parts: firstly, it can locally promote blood circulation and raise body temperature; secondly, it can increase the threshold value of pain of tissues with appropriate stimulation; thirdly, it can extend the tense and spasmodic muscles so that the illness can be eliminated.
2-3. Restore and treat injured soft tissues and reduce dislocated joints
Massage manipulations of tracting, traction and counter-traction, rotating and pulling or flicking-poking can reduce joint dislocation, join semiluxation, relocate the sprained soft tissue to normal position, restore slipped tendon, re-situate herniation of pulpiform nucleus, take out the embedded synovium, eliminate the pathogenic state of muscle spasm and local pain, promoting the recovery and reconstruction of the injured soft tissues.
2-4. Trip adhesion, dredge stenosis
When the soft tissues are injured, adhesion of the muscle, tendon, ligament, joint capsule, and others, as well as local bleeding and organization hematoma may cause a long-term pain and hinder the joint activities. Treatment, such as flicking-poking, joint lift-dragging, traction and counter-traction, rotating and pulling, can remove adhesion and facilitate the activity of joints.
In the body parts which have fiber-sheathed vessels of bones such as the tendon vessel of the long head of biceps, tendon vessels and tendon sheath of lexor hallucis longus and flexor digitorum at the processus styloideus of radius, there may, due to hyperosteogeny, chronic strain or attack of wind, cold and dampness, occur with tumefaction and hyperemia of the tendon and tendon sheath or exudation inside the sheath and then fibrosis, which will thicken the wall of the sheath, fetter the tendon inside the sheath and affect the extention-flexion movement of the joints. If it is not a serious case, the sheath will become constrictive, and snapping sounds will be heard while moving. If the case is a serious one, the local adhesion will become indurative, and the joints will lose its extension-flexion function. For tendons and sheaths with pathologic changes, local massage by plucking and continuous rhythmic finger-kneading or rolling in coordination with rolling-pulling, traction and counter-traction and other manipulations of passive movement of the joint can subdue swelling, stop pain, strip adhesion, enlarge constriction and relieve the snapping sound to restore the tendon to its normal sliding function in the sheath.
2-5. The tonifying and purging function of massage manipulations
Massage treatment takes manipulation as the most important means. In the course of diagnosis and treatment, according to the deficiency and excess of the patient's condition of constitution and illness, the massagists can choose such manipulations as tonifying, purging, mediating, exciting or restraining, all depending on whether the manipulations can be skillfully applied. A comprehensive survey of the clinical experience of the masters of both ancient and modern Chinese massage shows that the tonifying and purging effect of the manipulation is directly related with factors such as whether using a mild or powerful manipulation, whether with vigorous or soft performance, or whether with a quick or slow frequency, or what direction the force takes and how much time it lasts.
Generally speaking, the tonifying manipulation refers to the manual stimulation with less strength, soft performance and slow frequency along the route of channels and collaterals (anti-clockwise manipulation at the abdominal region), which excites, stimulates and strengthens the human body.
On the contrary, more powerful, vigorous but soft manual stimulations with quick frequency moving in the opposite direction of the channels and collaterals (clockwise manipulation at the abdominal region) for a short time are known as purging manipulation which has the function of restraining, tranquilizing the body and directly expelling pathogen. Besides, to-and-fro stimulations performed with moderate strength, frequency and time along the channels and collaterals are known as uniform reinforcing-reducing method, which is also called mediation method used frequently for regulating yin and yang and enhancing the function of the related internal organs.
But, all these manipulations mentioned above concerning tonifying and purging are relative and changeable in different clinical practice. Therefore, flexible choice and differentiation should be made in accordance with the specific conditions. Take the tonifying method for example, it may be divided into two kinds, namely, slow tonifying and quick tonifying. For quick tonifying, strong manipulation is used to stimulate the points along the regular channels while slow tonifying performed gently and slowly for a longer time along the related channels. The purging method consists of quick purging and slow purging. For quick purging, deep finger-nail-pressing is used with more strength in reverse direction of channel while slow purging is performed with less strength.
3. How to Learn Chinese Massage
Chinese massage, as one clinical branch of TCM, demands rich knowledge both in theory and practice. Professional massage doctors should have not only the knowledge of Western medicine, a good command of TCM diagnosis and treatment methods form upon an overall analysis of symptoms and signs, but also a good physical constitution and proficient manipulation techniques for clinical massage practice. So, the students in the massage line of TCM colleges in China must systematically study Classics on Massage, Theory on Massage Exercise, Manipula:ion of Massage, Basis of Massage, Massage Therapeutics, Children Massotherapy and other specialized courses. Moreover, they have to carry on strict physical exercise and technical training in manipulations.
In the study of basic medical courses, emphasis should be paid on the study of TCM theory as yin-yang, the five elements, ying-wei-qi-xue, channels and collaterals, viscera, causes of illnesses, four diagnostic methods and eight-principal-syndrome diagnosis and treatment based on overall analysis of symptoms and signs and on the study of anatomy, physiology, pathophysiology, pathoanatomy and physical diagnosis in Western medicine. Also required is the knowledge of the flowing courses of the fourteen regular channels and their relationship to the internal organs, the commonly used acupoints on the fourteen regular channels, the location of extra-ordinary points, the special points for massage, point selection, indications, human histology, motion function, etc.
In term of professional technical training, the first thing is to carry on such training step by step. During the training, attention should be paid not only to such things as strength, endurance, pliability and toughness but also to the psychological preparation, i. e., the strong will power and quality to bear hardships and strenuous work so as to get physically and psycologically prepared for the long-term professional massage work. Furthermore, stress should also be laid upon the serious study of the “movement structure" and "technical essentials" of various manipulations, and strict following-up of the training methods and steps, and assiduous and persevering practice of manipulating technique in its proper sequence so as to succeed in the three training phases as rice-bag training, human-body training and manipulating training for treating common diseases.
In a word, for those with rich knowledge of medical science, it is easy to succeed in practicing massage within a short time if there is a conscientious training, but difficult to reach a perfect command of the difficult manipulations such as single-finger massage, and rolling therapy without long-term training and practic.
4, Brief introduction to most-used manipulation
1. Pushing Manipulation with One-Finger Meditation
It refers to the manipulation as operator using the tip of the thumb, or the whorled surface of the thumb to push the region to be treated with combination movement of the shoulder relaxing, the elbow dropping, wrist hanging, elbow flexing and stretching cyclically and thumb flexion and extension, which bring the forearm and wrist joint to swing inward and outward.
2. Rolling Manipulation
Using minor thenar enunance and dorsoulnar as the force-applying surface, the practitioner lowers his shoulder, drops elbow with his arm erected and his palm setting upright, performs cyclical flexion, extension, inward and outward rotating swinging of both elbow joint and forearm, to effect the extension and flexion of the wrist joint rolling the round back of the hand to and fro on the region to be treated.
3. Kneading Manipulation This is a manipulation as kneading slowly and softly the therapeutic region to-and-pro with fingers, the bottom of the palm, major thenar eminance or the tip of the elbow. According to the different parts to be operated, it can be divided into middle-finger kneading manipulation, thumb-kneading manipulation, palm-root kneading manipulation, major-thenar kneading manipulation, elbow-kneading manipulation, etc.
4. Rubbing Manipulation It refers to rhythmically rubbing the therapeutic part in a circular motion with the palm or the palmar side of the operator's fingers touching the therapeutic region. Rubbing with the operator's palm is called palm-rubbing manipulation; rubbing with palmar side of the fingers is called fingers-rubbing manipulation.
5. Scrubbing Manipulation The rubbing and scrubbing therapeutic part to and fro along a straight line with the operator's palmar face, minor or major thenar eminance is called scrubbing manipulation. According to the different operating parts, this manipulation can be divided into three types: palm-scrubbing, minor-thenar scrubbing and major-thenar scrubbing.
6. Grasping Manipulation Grasping manipulation is carried out by symmetrically and slowly lifting and squeezing the therapeutic part, in combination with movements as holding, twisting, foulaging, kneading, pinching the same part with thumb, index finger, middle finger or all five fingers. Operation with the operator's thumb and index finger and middle finger is called three-fingers grasping manipulation; with five fingers is called five-fingers grasping manipulation.
7. Pressing Manipulation Pressing manipulation refers to such action as pressing the therapeutic parts continuously with the finger-tip, palm, palm-root or the tip of elbow, lightly or heavily, shallowly or deeply. According to the different manipulating parts, it can be divided into thumb-pressing manipulation, middle-finger-pressing manipulation, phalangeal-joint-pressing manipulation, palm-root-pressing manipulation, palm-pressing manipulation
8. Flat-pushing Manipulation Flat-pushing manipulation is performed by straightly pushing and scrubbing the operated part to and fro with the palm and thumb radial border, thumb perpendicular with the other fingers. It is also called palm-pushing manipulation.
9. Digital-pressing Manipulation Digital pressing is the manipulation performed by heavily pressing the deep layer tissue with the thumb, or middle finger tip, or the protrusive part of the proximal interphalangeal joints of the flexed middle finger, index finger and thumb. According to the different operating parts, it can be divided into thumb-pressing manipulation, middle-finger-pressing manipulation and phalangeal-joint-pressing manipulation
10. Digital-striking Manipulation Digital-striking technique is a manipulation performed by striking the therapeutic region with middle finger tip, or tip of thumb, fore and middle fingers, or the tips of five closed-up fingers. According to the different operating parts, it can be divided into three types: middle-finger striking, three-finger striking, five-finger striking manipulation.
11. Patting Manipulation The manipulation of patting or beating with empty palm on the body surface is called patting manipulation or patting-hitting manipulation
12. Tapping Manipulation
The manipulation of using the back of fist, palmar root, palmar center, minor thenar eminance, or the stick made of mulberry twigs to pound and hit the body surface is called tapping manipulation or striking manipulation
13. Vibrating Manipulation
With the tip of the middle finger or the palm as the force-giving points, vibrating manipulation is to stretch-flex the muscle group of forearm in a narrow range, swiftly and alternatively cause soft vibration which keeps conducting vibration on the treated region. It is also called vibrating trembling manipulation; the manipulation with the middle finger as the force-giving point is called finger-vibrating manipulation; that with the palm as the force-giving point is called palm-vibrating manipulation.
14. Foulage Manipulation
Two palms facing each other, they rapidly roll-knead the therapeutic part of the body with relative force and move upwards and downwards repeatedly. This is called foutage manipulation.
15. Holding-twisting Manipulation
Holding the therapeutic parts such as fingers and toes with the thumb and the forefinger and roll or knead it to and fro with relative force is called holding-twisting manipulation
Wudang Taoist Kung Fu Academy
Purple Heaven Palace
Mount Wudang Scenery Zone
ShiYan City, Hubei Province, China 442714
Tel: 0086-139-9820-6370 (foreign)
Tel: (0)-139-9820-6370 (domestic)