anmo tuina subject-student handbook

© Tyler J Rowe 2011

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Australian College of TCM & Qigong - Certificate of Advanced Qigong Studies Subject Outline Subject Anmo Tuina – Chinese Massage Presenter Tyler J. Rowe Duration 21 hours (14 x 1.5hr lecture/practical) Prerequisites TCM theory, Acupuncture point location Assessment Practical exam

10 x Practical worksheets Materials Needed Practice rice bags Massage cloths Student notes Recommended Text Sun Chengnan (1990) ‘Chinese Massage Therapy’

Shandong Science and Technology Press [reprinted as:- Sun Chengnan (2000) ‘Chinese Bodywork – A Complete Handbook of Chinese Therapeutic Massage’ Pacific View Press]

References

Chase, Charles & Yang Shou-zhong (1995) ‘The Systematic Classic of Acupuncture & Moxibustion by Huang-fu Mi a translation of the Jia Yi Jing’ Blue Poppy Press

Deadman, Peter & Al-Khafaji, Mazin (1998) ‘A Manual of Acupuncture’ Journal of Chinese Medicine Publications

Legge, David (1997) ‘Close to the Bone – The Treatment of Musculo-skeletal Disorder with Acupuncture and other Traditional Chinese Medicine’ Sydney College Press

Legge, David (2010) ‘Jing Jin – Acupuncture treatment of muscular system using the meridian sinews’ Sydney College Press

Maoshing Ni (1995) ‘The Yellow Emperor’s Classic of Medicine - A New Translation of the 'Neijing Suwen' with Commentary’ Shambhala Publications

Pritchard, Sarah (1999) ‘Chinese Massage Manual’ Piatkus Publishing: London

Wang, Ju-Yi & Robertson, J. (2008) ‘Applied Channel Theory in Chinese Medicine: Wang Ju Yi’s Lectures on Channel Therapeutics’ Eastland Press

Wu Jing-Nuan (1993) ‘Ling Shu or Spiritual Pivot’ University of Hawaii Press

Zhang Enqin (1990) ‘Chinese Massage’ Publishing House of Shanghai University of TCM

Zhang Yisheng (2002) ‘Tuinaology’ People’s Medical Publishing House


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Timetable

Week Lecture Practical

1 Introduction An mo Tui na Character meaning History & context in TCM References in classical texts –

内经素问 Nèijīng Sùwèn

灵枢 Língshū

甲乙经 Jiǎyǐjīng Specialities -

痹证学 Bì zhèng xué Rheumatology

外伤学 Wài shāng xué Traumatology

Demonstration Tuina treatment

2 Tuina Theory Characteristics of Tuina Functions & effects of Tuina Treatment prescription & sequence Media – cloth, herbal preparations Massage tools

Exercises Standing postures 少林内功 Shàolín Nèigōng ‘Internal

Cultivation Exercises’

3 Tuina Physiology

Structures – 筋 sinews, 骨 bones, 经 channels Diagnosis – palpation & assessment

Technique Palpation

滚法 Gun Fa Rolling

4 Techniques Revision of previous technique

一指禅推法 Yi Zhi Chan Tui Fa One Finger Meditation

摩法 Mo Fa Rubbing

擦法 Ca Fa Scrubbing

5 Techniques Revision of previous techniques

揉法 Rou Fa Kneading

拿法 Na Fa Grasping

按法 An Fa Pressing

推法 Tui Fa Pushing

6 Techniques Revision of previous techniques

击法 Ji Fa Tapping

振法 Zhen Fa Vibrating

搓法 Cuo Fa Foulageing

抖法 Dou Fa Shaking

摇法 Yao Fa Rotating

扳伸法 Ban Shen Fa Stretching

7 Treatment of the Head & Neck Assessment – palpation & movement Main treatment sequence Common ailments & variations Stiff neck Cervical Osteoarthritis Headache Rehabilitative exercises

Demonstration & practice Students to perform sequence in pairs with supervision followed by discussion

8 Treatment of the Thoracic Region Assessment – palpation & movement Main treatment sequence Common ailments & variations Intercostal strain Muscular spasm Disc injury Rehabilitative exercises



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9 Treatment of the Lower Back Assessment – palpation & movement Main treatment sequence Common ailments & variations Lumbar sprain Disc injury Arthritis Rehabilitative exercises


10 Treatment of the Shoulder Assessment – palpation & movement Main treatment sequence Common ailments & variations Sprain Tendonitis Frozen shoulder Rehabilitative exercises


11 Treatment of the Upper Limb Assessment – palpation & movement Main treatment sequence Common ailments & variations Tendonitis Carpel Tunnel Syndrome Rheumatoid Arthritis Rehabilitative exercises


12 Treatment of the Pelvis & Hip Assessment – palpation & movement Main treatment sequence Common ailments & variations Sciatica / Piriformis Syndrome Arthritis Hamstring / Groin Strain Rehabilitative exercises


13 Treatment of the Lower Limb Assessment – palpation & movement Main treatment sequence Common ailments & variations Tendonitis / Ankle Strain Plantar fasciitis Shin splints Rehabilitative exercises


14 Practical Worksheets 10 Massages to be completed and reported on by this date. Questionnaire and self assessment to be filled on for marking.

Practical Exam Demonstration & discussion of random main treatment sequence & variations


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1) Introduction 1.1 The meaning of ‘Chinese Massage’

按摩推拿 Ànmó Tuīná - Press rub Push grasp

1.2 Eight ‘Branches’ of Chinese Medicine

针灸 Zhēnjiǔ - Acupuncture & Moxibustion

草药 Cǎoyào - Herbal Medicine

食疗 Shíliáo - Dietary Therapy

推拿 Tuīná - Massage Therapy

武术 Wǔshù - Martial Arts

气功 Qìgōng - Meditation

风水 Fēngshuǐ - Geomancy

数术 Shùshù - Astrology

1.3 Historical references in the classics

内经素问 Nèijīng Sùwèn

Chapter 1 – The Universal Truth ‘In the past, people practiced the Dao, the Way of Life. They understood the principle of balance, of yin and yang, as represented by the transformations of the energies of the universe. Thus, they formulated practices such as Daoyin, an exercise combining stretching massaging, and breathing to promote energy flow, and meditation to help maintain and harmonise themselves with the universe.’

Chapter 24 – Channel Constituents and Acupuncture Techniques People who are repeatedly startled or traumatised have an obstruction of qi and blood in the channels and collaterals. They can manifest numbness or paralysis of the extremities. One should use tuina, massage, and herb wine in these cases.

灵枢 Língshū ‘Spiritual Pivot’

…the conduct of the movement of qi, by massage, moxibustion, ironing out, needling, fire needling or drinking medicines. - Scroll 7 part 42. The Propagation of Disease The round needle has the shape of an egg. It is used for rubbing and massage, to divide and to separate so as not to injure the muscles and flesh. - Scroll 1 part 1. Of Nine Needles and Twelve Source Points

It is necessary to massage the channels first. - Scroll 1 part 4. Noxious Qi’s Disease It is necessary to first massage the locations for as long a time as there is a resonance in hand. - Scroll 8 part 52. Protective Qi

When the channels are shallow, do not needle until the channel has been massaged so that the essence does not come out, then needle. - Scroll 2 part 7. On Governing the Needles To harmonize, press and massage that qi which is excessive in the channels. - Scroll 4 part 19. To Qi of the Four Seasons


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When the needling is finished, massage to finish the pain at this location. When the needling is finished, massage until it is established that the pain has stopped. - Scroll 5 part 26. Assorted Diseases

针灸甲乙经 Zhēnjiǔ Jiǎyǐjīng ‘The Systematic Classic of Acupuncture and

Moxibustion’ Throughout the course of their therapy [foot yangming channel sinew], massage should be applied. – Book Two verse 6. Channel Sinews

To treat them [central region excess], cultivation of qi and massage are appropriate. – Book Six verse 2-3. Great Treatise on the Favourable & Unfavourable, Root & Branch of Disease, Physiographic Characteristics, and Configurations & Orientations

At this juncture [liver bi], massage and acupuncture are indicated… At this point [spleen wind] massage, medication, and ‘fire-branding’ are indicated… At this point [shan conglomeration], massage and medication are indicated. - Book Eight verse1-1. On the transmission of Disease Among the Five Viscera Producing Cold & Heat

In the case of tugging and tension [in the muscles], one must perform cultivation of qi and massage to promote circulation. – Book Ten verse 1-1. The Contraction of Disease by Yin Causing Bi

1.4 Specialities

痹证学 Bìzhèngxué ‘Arthralgia Syndrome’ (Rheumatology)

外伤学 Wàishāngxué ‘External Injury’ (Traumatology)

正骨 Zhènggǔ ‘Bone Setting’ (Orthopaedics)


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2) Theory 2.1 Characteristics of Tuina

Definition – the manual manipulation of points, muscles, bones and sinews with the hand, elbow or knee, for the purposes of alleviating injury and illness, maintaining health, and preventing disease, through stimulation or reduction of the channels and pathways.

Of the many different techniques or manoeuvres in Tuina, they all retain certain characteristics which are essential to good practice.

Requirements -

Smoothness

Strength

Stability

Rhythm

Flexibility 2.2 Functions & effects of Tuina Functions

Promote circulation of qi and relieve stagnation

Invigorate xue and dispel stasis

Relax the sinews Indications

Soft tissue injury

Chronic joint pain

Muscular dysfunction & atrophy

Paediatric Illness* Contraindications

Fracture & Dislocation

Open wounds

Deep Vein Thrombosis

Spinal Manipulation* 2.3 Treatment prescription & sequence

i. Opening techniques – short duration, superficial, gentle methods ii. Channel movements – long duration, moderate strength and depth

iii. Point manipulations – deep tissue, specific locations & mobilisations 2.4 Media – cloth, herbal preparations Traditional media used in Tuina is a cloth. Usually cotton or other natural fibre, the cloth, measuring anywhere from 250mm to 2000mm square, serves three main purposes.

Firstly it negates the need for oil. Most massage oils are inappropriate for use with Tuina techniques. They make the contact area slippery and difficult to handle or control. Skin on skin contact can lead to damage of the superficial skin layers, becomes uncomfortable, and in time sebaceous oil and sweat secretions render this


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‘media’ useless. Tuina techniques can be completed smoothly and most effectively with the cloth.

Secondly, the cloth is a barrier of modesty. Much of the TCM we practice today was in ancient times practiced on the imperial family. Imperial physicians were the ‘best of the best’ in TCM, their practices were more likely to be recorded, passed on and taught in the early medical schools. Though doctors had respect in the palace, it was unlikely they would have been allowed to directly touch the empress for instance. True, her pulse was usually taken through a piece of silk (with her hand passed through the doorway from another room) rather than risk this contact. The same extends to a degree into Chinese society, where they tend to be more conscious of exposing body parts than in the west.

Thirdly in the north of China and the capital Beijing (where much of our TCM comes from – they had more works of literature, the palace and a large population there) it can get particularly cold in winter (in excess of -10o) and its acts as somewhat of an insulator.

Chinese Massage also utilises a number of herbal oils and liniments. These are

prescribed and used according to functions and indications of the herbal ingredients. They are usually applied as an adjunct to the therapy (after the massage) rather than used as media. Most commonly used are herbal formulas to:-

invigorate xue and dispel stasis

promote qi and disperse stagnation

clear heat and reduce swelling

disperse bruising and alleviate pain

promote regeneration of tissue and mend bone

relax sinews and strengthen joints

alleviate bi syndromes (wind-cold-damp)

release the exterior Most often in sesame oil, peanut oil, rice spirit, vinegar or water bases. Commonly used prepared products include 正骨水 Zheng Gu Shui, 红花油 Hong Hua You, 跌打酒

Die Da Jiu etc… 2.5 Massage tools

Massage clubs have been used over the years in some schools of Tuina. They can be useful for weaker practitioners, or when dealing with particularly strong clients. Generally they are used to intensify treatments. Traditionally made of horn, bamboo or mulberry (though now plastics and rubber are often substituted) the commonly used clubs include clubs shaped like digits, palms and elbows. Indeed virtually substituting any part of the arm or hand. Ball-like clubs (with a ball attached to a stick), chopping and patting clubs (shaped like a hand on a stick) and small rubber mallets can also be found in use. The rice bag is a traditional Tuina training device. It is considered the best way to practice before moving to a live patient. The heavy cotton or canvas bag, usually 200-300mm square, is filled with rice and sealed. A student can then perform many of the techniques, developing skill, strength and rhythm, with this device. Some traditional schools believed mastery of Tuina could only be gained once the students rolling had turned the rice within completely to power.


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2.6 Basic Training Exercises

Physical training of the practitioner has long been a part of the study of Tuina.

Many different sets of 气功 Qigong and 武术 Wushu exercises are used including

famous sets such as the 八段锦 Ba Duan Jin - Eight Sections Brocade Exercises and the

易筋经 Yi Jin Jing - Sinew Transforming Exercises. All the systems use similar basic stances and hand patterns. Perhaps the most commonly used in training of Tuina are the 少林内功 Shàolín Nèigōng ‘Internal Cultivation Exercises’.

a) Stances 站步 Zhàn bù ‘Upright stance’

马步 Mǎ bù ‘Horse stance’

弓步 Gōng bù ‘Bow stance’ b) Postures 伸臂撑掌 Shēnbì chēngzhǎng ‘Extend arms support palms’

前推八匹马 Qiántuī bāpǐmǎ ‘Push forward eight horses together’

倒拉九头牛 Dàolā jiǔtóuniú ‘Pull backward the tail of nine oxen’

凤凰展翅 Fènghuáng zhǎchì Phoenix spreads its wings’

霸王举鼎 Bàwáng jǔdǐng ‘Overlord holds up the cauldron’

顺水推舟 Shùnshuǐ tuīzhōu ‘Push the boat along the current’

单掌拉金环 Dānzhǎng lājīnhuán ‘Pulling the golden ring with one hand’

怀中抱月 Huàizhōng bàoyuè ‘Hold the moon in the centre of the chest’

仙人指路 Xiānrén zhǐlù ‘Immortal points to the road’

平手托塔 Píngshǒu Tuōtǎ ‘Draw the pagoda in the hand’

海底捞月 Hǎidǐ lāoyuè ‘Fish out the moon from the bottom of the sea’

运掌合瓦 Yùnzhǎng héwà ‘Palm covering over the roof tile’

风摆荷叶 Fēngbǎi héyè ‘Wind sways lotus leaves’

两手托天 Liǎngshǒu tuōtiān ‘Two hands hold up heaven’

单风朝阳 Dānfēng cháoyáng ‘Single wind in the rising sun’

顶天抱地 Dǐngtiān bàodì ‘Sustaining the heaven and holding the earth’

力劈华山 Lìpī huàshān ‘Strength to split magnificent mountain’

三起三落 Sānqǐ sānluò ‘Three rising and three sinking’

乌龙钻洞 Wūlóng zuāndòng ‘Dark dragon dives into the cave’ 饿虎扑食 Èhǔ pūshí 'Hungry tiger pouncing on its prey'


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3) Physiology 3.1 Structures 骨 gǔ bones, 经 jīng channels, 筋 jīn sinews

“The muscle channel of the Leg Tai Yang Bladder begins in the little toe of the foot, goes up to connect to the anklebone, then goes diagonally up to connect to the knee. A lower branch follows the lateral side of the foot to connect at the anklebone, then mounts and follows the heel to connect in the crease of the knee. A separate branch connects to the lateral part of the leg and ascends to the crease of the knee along the medial side, then goes from the centre of the crease of the knee to connect to the buttocks. It continues up along the pinch of the backbone on both sides to the neck. A branch separates and enters to connect with the root of the tongue. A straight branch connects the neck to the occipital bone to the top of the head, then travels down in the space between eyebrows and eyes to connect in the nose. Another branch goes along the upper net of the eye and eyelid, then descends to connect with the cheekbone. Another branch goes from behind the armpit on the lateral side to connect at Co15. Another branch enters the armpit, goes up to emerge at the supraclavicular fossa, then moves up to connect to the mastoid process. Another branch comes out at the supraclavicular fossa, and goes diagonally up into the cheekbones. The muscle channel of the Leg Shao Yang Gallbladder begins in the fourth toe, then travels up to the lateral anklebone and ascends along the lateral side of the leg to connect at the lateral side of the knee. A branch separates beginning on the lateral side of the thigh bone, then travels up through the thigh, where in the front it connects with St32 and in the back it connects with the buttocks. A straight branch ascends and rises to the depression under the bottom rib. It then travels up to the front side of the armpit, links with the region of the chest, and connects in the supraclavicular fossa. A straight branch goes up and comes out at the armpit, goes through the supraclavicular fossa to come out in front of the Leg Tai Yang Bladder, and then travels to behind the ear. It goes up to the corner of the forehead and makes a junction at the top of the head, descends and travels to the chin, and goes up to connect with the cheekbones. A branch connects in the lateral corner of the eye and is the lateral connective. The muscle channel of the Leg Yang Ming Stomach begins in the second toe and connects with the third toe, goes to the top of the foot, goes diagonally upward and laterally along the leg bone. It continues up to connect to the lateral side of the knee, and goes straight up to connect to the pivot of the thigh, ascends to follow the flanks, and is attached to the backbone. A straight branch goes up and follows the leg bone to connect with the knee. A branch connection goes along the leg bone and joins the Leg Shao Yang Gallbladder. Another straight branch goes up, follows St32, ascends and connects to the thigh, then assembles in the yin organs. Then it ascends and spreads in the abdomen to reach and connect to the supraclavicular fossa. It goes up the neck and the pinch of the mouth on both sides to meet in the cheekbones, descends to connect with the nose, then goes up to meet the Leg Tai Yang Bladder. The Leg Tai Yang Bladder is the upper eyelid. The Leg Yang Ming Stomach is the lower eyelid. Another branch goes from the cheek to connect with the front of the ear.


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The muscle channel of the Leg Tai Yin Spleen begins at the tip of the big toe on its medial side. Then it goes up to connect to the medial anklebone. A straight branch makes a path up along the leg bone to the medial side of the knee, ascends to the yin side of the thigh to connect with the upper thigh and assemble in the yin organs. It goes up the abdomen to connect in the navel, follows the base of the abdomen to connect with the flanks, then spreads in the middle of the breast. An internal branch is attached to the backbone. The muscle channel of the Leg Shao Yin Kidney begins in the bottom of the foot on a line with the little toe. Then it goes together with the muscle channel of the Leg Tai Yin Spleen and travels diagonally to below the medial anklebone to connect with the heel and join the muscle channel of the Leg Tai Yang Bladder. Then it goes up to connect with the medial side of the leg and goes together with the muscle channel of the Leg Tai Yin Spleen to ascend to the yin side of the thigh. It continues to the yin organs, then follows the backbone along the inner pinch of the spine along both sides until it reaches the back of the neck and connects to the occipital bone, and joins the muscle channel of the Leg Tai Yang Bladder. The muscle channel of the Leg Jue Yin Liver begins on the top of the big toe, then goes up to connect to the front of the medial anklebone, ascends and follows the leg bone. It continues up along the inside to connect below the tibia, then continues up along the yin side of the thigh to connect with the yin organs, where it connects with all of the muscle channels. The muscle channel of the Arm Tai Yang Small Intestine begins on the top of the little finger, connects with the wrist, follows the medial side of the arm to connect with the elbow behind the medial epicondyle, which, when snapped, has corresponding sensations on the top of the little finger. It continues by entering and connecting to the bottom of the armpit. A branch travels behind the armpit to ascend and to wind around the shoulder blade, then follows the neck to come out and travel to the front of the Leg Tai Yang Bladder, and connects behind the ear on the mastoid process. Another branch enters the middle of the ear. Another straight branch comes out above the ear, descends to connect to the chin and jaws, then goes up to subordinate the lateral corner of the eye. The muscle channel of the Arm Shao Yang Sanjiao begins on the tip of the ring finger on the side of the little finger and goes to connect at the wrist. It ascends along the middle of the arm and connects to the elbow, goes up around the lateral side of the upper arm, and ascends to the shoulder. It travels to the neck to join with the Arm Tai Yang Small Intestine. A branch from the point at the bend of the jaw enters to connect with the root of the tongue. Another branch goes up to the bend of the teeth and jaws, goes along in front of the ear, then subordinates the lateral angle of the eye. Then it ascends, mounting a line above the jaw to connect with the corner of the forehead.

经筋 jīngjīn channel sinews (灵枢 Língshū ‘Spiritual Pivot’ Scroll 4 part 13)


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The muscle channel of the Arm Yang Ming Large Intestine begins on the tip of the forefinger on the side next to the thumb. It connects with the wrist and moves up, follows the forearm, then goes up to connect with the outside of the elbow. It ascends the upper arm to connect with the shoulder. A branch winds around the shoulder bone to the pinch along both sides of the backbone. A straight branch goes along the shoulder bone and ascends the neck. Another branch goes up the cheek to connect the cheekbones. A straight branch ascends and comes out in front of the Arm Tai Yang Small Intestine, mounts to the left comer of the forehead, links with the channel of the head, and moves down to the right chin and jaws. The muscle channel of the Arm Tai Yin Lung begins on the top of the thumb, then travels along the thumb to connect to the rear of the thenar eminence, then moves to the lateral side of the radial pulse and ascends along the arm to connect to the center of the elbow. Then it mounts the medial surface of the upper arm to enter the bottom of the armpit, comes out in the supraclavicular fossa, and connects to the front of the shoulder joint. On top there is a connection in the supraclavicular fossa, below there is a connection in the base of the chest, where it spreads and goes through the cardiac orifice, assembles, then goes down to the lowest rib. The muscle channel of the Arm Jue Yin Pericardium begins in the middle finger, then travels together with the muscle channel of the Arm Tai Yin Lung to connect to the medial side of the elbow. It then ascends the yin side of the upper arm to connect with the bottom of the armpit, and spreads down both to the front and back by clasping the ribs. A branch enters the armpit and spreads to the centre of the chest to connect with the cardiac orifice. The muscle channel of the Arm Shao Yin Heart begins on the inner side of the little finger, then connects to the pisiform bone, the ulna, and goes up to connect to the medial side of the elbow. Then it goes up to enter the armpit, intersects with the Arm Tai Yin Lung, and clasps the base of the nipple to connect with the centre of the chest. Then it goes along the cardiac orifice and descends to connect with the navel.

3.2 Diagnosis

气 Qì (Stagnation) 血 Xuè Blood (Stasis)

Moving fixed

Generalised localised

Dull sharp

worse with emotional stress unaffected by emotions

虚 Xū Empty 实 Shí Full

Chronic acute

aggravated by tiredness aggravated by stillness

alleviated by rest alleviated by movement

weakness & flaccidity stiffness & swelling

enjoys pressure tenderness


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3.3 Assessment

a) Questioning – location, nature, duration, frequency, radiation, aggravating, relieving

b) Observing – alignment/posture, skin colour, vasculation, reproducing pain

Palpate – passive range of movement, resistance, 扪 mén ‘scan’ temperature, 循 xún

‘go-along’ channels, 按 àn ‘press’ ashi-tender points, 拨 bō ‘pluck’ sinews


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4-6) Techniques 1. 滚法 Gǔn fǎ – Rolling

Frequency 120-180 b/p/m

Intensity light to strong

Penetration deep

Location thick muscled areas, static or dynamic

Action promote qi and invigorate xue

Tools dorsal aspect of hand

Method roll obliquely from the 5th knuckle towards the root of the thumb, fingers relaxed, hand open

2. 一指禅推法 Yī zhǐ chán tuī fǎ - One Finger

Meditation



Penetration deep

Location points or channels, static or dynamic

Action promote qi, invigorate xue and dispel stasis

Tools radial aspect of thumb, thenar eminance

Method flex and extend the thumb, taking care not to contact with the knuckles

3. 摩法 Mó fǎ – Rubbing


Intensity light

Penetration superficial

Location systematic, dynamic

Action opens channels

Tools palmer aspect of hand

Method circling clockwise or anti-clockwise, with a loose hand

4. 擦法 Cā fǎ – Scrubbing


Intensity moderate


Location systematic, dynamic

Action warm channels

Tools palmer aspect of hand, blade of palm

Method vigorously rub longitudinally or horizontally, with a firm hand


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5. 揉法 Róu fǎ – Kneading



Penetration deep

Location ridges, dynamic or static


Tools palmer aspect of fingers

Method pinch and squeeze with the finger and thumb pads, using a wide grip

6. 拿法 Ná fǎ - Grasping


Intensity strong

Penetration deep

Location ridges, static


Tools palmer aspect of hand and fingers

Method clasp the finger pads toward the palm, lift using a narrow grip

7. 按法 Àn fǎ - Pressing


Intensity strong

Penetration deep

Location points, static

Action promote qi, invigorate xue and dispel stasis

Tools tip of finger/thumb, root of palm, knuckle, fist, elbows, knees

Method apply firm vertical pressure, optional circling 8. 推法 Tuī fǎ – Pushing


Intensity strong

Penetration deep

Location thick muscled areas, dynamic

Action promote qi, invigorate xue and disperses stasis

Tools thumb or finger pads, root of palm, elbow

Method obliquely apply firm pressure then slide along the surface


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9. 击法 Jī fǎ – Striking

Frequency 240-360

Intensity moderate

Penetration deep

Location thick muscled areas, dynamic or static

Action promote qi and invigorate xue, relax sinews

Tools blade of palm, fist, dorsum of hand, cupped hand, crane’s beak

Method alternately strike in a drumming action with both hands 10. 振法 Zhèn fǎ – Vibrating


Intensity strong

Penetration deep

Location thick muscled areas, static

Action invigorate xue and dispel stasis

Tools finger tips, palmer surface of hand

Method place finger tips/palm vertically over area, thumb pulled in, shake horizontally and longitudinally

11. 搓法 Cuō fǎ – Foulageing


Intensity light


Location limbs, neck or costal region, dynamic or static

Action promote qi and invigorate xue, relax sinews

Tools palmer surface of hand

Method with palms facing inward to the contact area create a rolling action by alternately moving the hands upward and downward

12. 抖法 Dǒu fǎ – Shaking


Intensity light to moderate

Penetration deep

Location limbs, dynamic or static

Action relax sinews

Tools hand

Method firmly grasp the extremity with both or one hand (the other hand can support the joint), shake upward and downward


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13. 摇法 Yáo fǎ – Rotating


Intensity moderate

Penetration deep

Location limbs and neck, dynamic

Action relax sinews

Tools hands

Method firmly grasp the extremity with both or one hand (the other hand can support the joint), progress the joint through the normal range of movement.

14. 扳伸法 Bān shēn fǎ – Stretching

Frequency 1-2 b/p/m


Penetration deep

Location joints, static

Action relax sinews

Tools hands, elbows, knees

Method various passive flexibility exercises depending upon joint


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7) Treatment of the Head & Neck

• Common Ailments headache, stiff neck, cervical osteoarthritis

• Clinical Manifestations dull ache or sharp pain, rigidity, spasms, tenderness, restricted range of movement, dizziness, light headedness, radiation to the upper limb, parasthesia, neuropathy, photosensitivity, nausea, nasal discharge or congestion, redness, oedema, heat

• Assessment observation of asymmetry, rotation, flexion, extension and side bending, palpation of Leg Taiyang Bladder, Leg Shaoyang Gallbladder, Arm Taiyang Small Intestine & Arm Yangming Large Intestine

• Main Treatment Sequence Foulageing – neck Kneading & Grasping – neck, Gb20,21, Bailao One finger meditation - Anmain, Gb20, Bl10, Du16 Rolling – neck & nape Pressing – Anmain, Gb20, Bl10,60, Du16, Si3, 13 Scrubbing – Du14 Stretching & Rotating

• Modifications Headache: Kneading – scalp Tapping – scalp Pressing – Taiyang, Co4, Lv3, Bitong, Yintang Stiff neck: Pressing - Gb39, Luozhen Osteoarthritis: Pressing – Bl11 Pushing – Bailao, Bl11

• Rehabilitation Sash rotation, flexion and side bending (passive and resited)


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8) Treatment of the Thoracic Region

• Common Ailments intercostal strain, muscular spasm, subluxation of vertebrae

• Clinical Manifestations dull ache or sharp pain, rigidity, spasms, tenderness, restricted range of movement, radiation to the head and neck or lumbar region, shortness of breath, redness, oedema, heat, dislocation of vertebrae

• Assessment observation of symmetry during breathing, rotation, flexion, extension and side bending, palpation of Leg Taiyang Bladder, Leg Shaoyang Gallbladder & Arm Yangming Large Intestine

• Main Treatment Sequence Rubbing – thoracic One finger meditation – Bl, Jiaji, Du Rolling – Bl, Jiaji, Du Pressing – Si13, Bl, Jiaji, Du Grasping – Bl, Du Pushing - Bl, Jiaji Striking – Bl Scrubbing – Bl Foulageing – Costal Stretching

• Modifications Intercostal strain: Pressing – Lv13, Gb25, Sp21 Muscular spasm: Pressing – Bl17, 46 Subluxation of vertebrae: Pressing – Gb34, Si3, Sj5

• Rehabilitation Sash cross on back


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9) Treatment of the Lower Back

• Common Ailments acute lumbar sprain, disc pathology, arthritis

• Clinical Manifestations dull ache or sharp pain, rigidity, spasms, tenderness, restricted range of movement, radiation to thoracic or pelvis and lower limb, parasthesia, neuropathy, weakness, tenderness, redness, oedema, heat or coldness, compensatory curvature deformities, narrowing of intervertebral spaces, vascular congestion, constipation

• Assessment observation of symmetry, rotation, flexion, extension and side bending, palpation of Leg Taiyang Bladder & Leg Shaoyang Gallbladder

• Main Treatment Sequence Rubbing – lumbar One finger meditation – Bl, Jiaji, Du, Yaoyan Rolling – Bl, Jiaji, Du Pressing – Bl, Jiaji, Du, Yaoyan Grasping – Bl, Du Pushing - Bl, Jiaji Striking – Bl Scrubbing – Bl, Jiaji, Du, Yaoyan Stretching Rotating

• Modifications Lumbar sprain: Pressing – Bl40, 60, Yaoytong Disc Injury: Pressing – Bl25, 31-33, 54, Si3 Scrubbing - Gao Arthritis : Pressing – Du4, Bl23, 57 Pushing - Gao

• Rehabilitation Sash assisted four-point core exercises, lumbar and hamstring stretches


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10) Treatment of the Shoulder

• Common Ailments supraspinatus tendonitis, acromio-clavicular sprain, frozen shoulder

• Clinical Manifestations dull ache or sharp pain, worse at night, rigidity, spasms, nodular masses, tenderness, restricted range of movement, radiation to thoracic, neck, upper limb, parasthesia, neuropathy, atrophy, joint luxation, swelling, tenderness, redness, oedema, heat or coldness

• Assessment observation of symmetry, flexion, extension, internal and external rotation, adduction, abduction, scaption, palpation of Arm Taiyang Small Intestine, Arm Yangming Large Intestine, Arm Shaoyang Sanjiao & Arm Jueyin Pericardium

• Main Treatment Sequence Rubbing – shoulder Kneading & Grasping – Co, Sj One finger meditatn – Gb21, Co15, Sj14, Si9-13 Rolling –Co, Si, Sj Pressing – Gb21, Co15, Sj14, Si9-13 Pushing – Co, Sj Striking– Co, Si, Sj Scrubbing – Co, Si, Sj Foulageing – Co Stretching Rotating Shaking

• Modifications Tendonitis: Pressing – Co11, 16, Sj5, Gb34 AC joint sprain: Pressing – Jianqian, Jianneiling Frozen shoulder: Pressing – Co4, St38 Pushing - Bl41

• Rehabilitation Health ball rotations on wall, Bamboo cane stretches


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11) Treatment of the Upper Limb

• Common Ailments tendonitis, carpel tunnel syndrome, rheumatoid arthritis

• Clinical Manifestations dull ache or sharp pain, rigidity, spasms, nodular masses, tenderness, restricted range of movement, radiation to shoulder, parasthesia, neuropathy, atrophy, weakness, joint deformity, swelling, tenderness, redness, oedema, heat or coldness

• Assessment observation of symmetry, flexion, extension, rotation, adduction, abduction, palpation of Arm Taiyang Small Intestine, Arm Yangming Large Intestine, Arm Shaoyang Sanjiao, Arm Taiyin Lung, Arm Shaoyin Heart & Arm Jueyin Pericardium

• Main Treatment Sequence Rubbing – arm Kneading & Grasping – Lu, Sj, Co One finger meditatn – Co10, 11, Lu3, 5, Pc3, 4, Sj5 Pressing – Co4, 5, 10, 11, Lu3, 5, 10, Pc3, 4, 6, 8, Sj2, 5, 10, Si3, 6, 8, Ht3, 8 Rolling - Lu, Sj, Co Pushing/Scrubbing - Lu, Sj, Co, Pc Foulageing – Lu, Sj, Co Stretching Rotating Shaking

• Modifications Tendonitis: Plucking - tendon Pressing – epichondyle points Carpel tunnel: Pushing – Pc7, Sj4 Arthritis: Pinching – Shixuan Pressing – baxie, shangbaxe

• Rehabilitation Health ball rotations, Bamboo cane stretches


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12) Treatment of the Pelvis & Hip

• Common Ailments sciatica/piriformis syndrome, arthritis, muscular strain

• Clinical Manifestations dull ache or sharp pain, rigidity, spasms, nodular masses, tenderness, restricted range of movement, radiation to lower back or lower limb, parasthesia, neuropathy, atrophy, altered gait, weakness, swelling, tenderness, redness, oedema, heat or coldness

• Assessment observation of symmetry, flexion, extension, rotation, adduction, abduction, palpation of Leg Taiyang Bladder, Leg Shaoyang Gallbladder, Leg Yangming Stomach, Leg Taiyin Spleen

• Main Treatment Sequence Rubbing – hip Kneading & Grasping – Gb, St Rolling - Bl, Gb Pressing – Bl36, 54, Gb29, 30, 34 Pushing – Bl, Gb Striking– Bl, Gb Scrubbing – Bl, Gb Foulageing – Hip Stretching Rotating Shaking

• Modifications Sciatic/Piriformis: Pressing – Jiaji, Bl40, 57, 60, Gb41 Arthritis: Pushing/Scrubbing - Gao Muscular strain: Pressing/Pushing – Bl37, Sp10, 11, St31, Lv8

• Rehabilitation Sash assisted lumbar & hamstring stretch, plum blossom stake rolling


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13) Treatment of the Lower Limb

• Common Ailments tendonitis/ankle sprain, plantar faciitis, shin splints

• Clinical Manifestations dull ache or sharp pain, rigidity, spasms, nodular masses, tenderness, restricted range of movement, radiation to lower back or limb, atrophy, parasthesia, neuropathy, altered gait, weakness, swelling, tenderness, redness, oedema, heat or coldness, crepitus, vascular congestion

• Assessment observation of symmetry, flexion, extension, rotation, pronation, supination, palpation of Leg Taiyang Bladder, Leg Shaoyang Gallbladder, Leg Yangming Stomach, Leg Taiyin Spleen, Leg Shaoyin Kidney, Leg Jueyin Liver

• Main Treatment Sequence Rubbing – leg Kneading & Grasping – Bl, Gb, St One finger meditatn – Bl37, 40, 57, Sp6, 9, 10, Kd1 Pressing – Xiyan, St36, Sp6, 9, 10, Bl37, 40, 57, 60, Gb34, 41, Kd3 Rolling - Bl, Gb, St, Kd Pushing/Scrubbing – Bl, Gb, St, Kd Foulageing – Lv, Gb Stretching Rotating Shaking

• Modifications Tendonitis: Pressing – Gb40, St41, Lv4, Kd4 Plucking - tendon Fasciitis: Pressing - Bl61, 62, St43, Sp3,4, 3, Kd2 Grasping Shin splints: Pressing/Pushing – Lv5, Kd7 Striking – St, Lv/Kd

• Rehabilitation Plum blossom stake stepping and rolling


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14) Practical Assessment Sheets Sample

Student Name your name

Date of the massage

Client Name the person massaged

Date of Birth the client’s

Gender the client

Main Complaint

Duration History Medications?

Clinical Manifestation (signs & symptoms)

Nature Location Intensity Frequency Duration Aggravated/Relieved

Assessment Observation Palpation Testing

Diagnosis Qi Stagnation/Xue Stasis Xu/Shi Heat/Cold

Prescription Techniques Channels Points Duration

Was the style of massage explained? How is it different?

client to provide this information

Was the massage appropriate for your needs? If no, why?


Was the massage comfortable? Set up well? If not, why?


Was the massage smooth and consistent? Or irregular/jumpy?


Was the massage too heavy or too soft?


Was the massage too fast or too slow?


Could the massage have been improved in any way?


Did the signs and symptoms reduce after the massage?


Did you enjoy the massage?


Client Signature client to provide this information


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TUINA WORKSHEET # …

Student Name

Date

Client Name

Date of Birth

Gender

Main Complaint (dur, hist, med)

Clinical Manifestations - S&S (nat, loc, int, freq, dur, agg, rel)

Assessment (obs, palp, test)

Diagnosis (qi/xue, xu/shi, hot/cold)

Treatment (tech, jl, pts, dur)

Was the style of massage explained? How is it different?

Was the massage appropriate for your needs? If no, why?

Was the massage comfortable? Set up well? If not, why?

Was the massage smooth and consistent? Or irregular/jumpy?

Was the massage too heavy or too soft?

Was the massage too fast or too slow?

Could the massage have been improved in any way?

Did the signs and symptoms reduce after the massage?

Did you enjoy the massage?

Client Signature

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