Tuina: Chinese Manual TherapyTraditional Chinese Medicine way to health

24 JUNE 2019, IGOR MICUNOVIC

Tuina is the grandmother of all forms of massage and body work that exist today

Tuina 推拿, or Chinese massage therapy, is one of the four main branches of traditional Chinese medicine. Although

very ancient, it is relatively new to majority. Tuina therapy dates back to around 3000 BC, making it the grandmother

of all forms of massage and body work that exist today, from shiatsu, reflexology, chiropractics to osteopathy and

beyond.

Tuina is different from other forms of massage with specific emphasis on medical factor, such as treatment of specific

illnesses related to internal organs, or muscular - skeletal systems as well. To become a Tuina practitioner it's not an

easy task. It is of utmost importance to master Chinese Medicine theory and practice, with detail knowledge of modern

medicine, in particular anatomy, physiology and pathology.

Discovery of ancient oracle bones and tortoise shells with inscriptions related to shamanistic tuina treatments, clearly

describe ancient spiritual usage of Tuina along the centuries.

Tuina very first massage techniques were born instinctively in order to relieve the pain and regain mental clearance.

In old times, medicine and supernatural beliefs were inseparable, whereas shamans were the first doctors.

During Zhou dynasty (700–481 BC), Chinese Medicine referred Tuina massage as ‘An Wu’ 按务(farm massage). At about

those early times massage became known as Anmo 按摩. Ancient ones discovered that An 按 (pressing) could stop

bleeding and Mo 摩(rubbing) would ease pain and reduce swelling.

Famous Dr Bian Que 扁鹊 (401 BC to 301 BC), combined massage and acupuncture. In famous medical book Huang di

neijing ⻩帝内经 (Internal medicine of the Yellow Emperor) during Qin dynasty (221–207 BC) massage therapy was

called Moshou 摸⼿ (hand rubbing). This medical book includes sections related to massage therapy, with descriptions

of 12 techniques and its therapeutic effects.

Doctor Zhang Zhong Jing 张仲景 (AD 142–220) applied principles of using herbal ointments in massage therapy to

increase the therapeutic effects. This process was called Gao mo 搞莫 (ointment massage). Hua Tuo 华佗, China’s first

recorded surgeon, mentions Gao mo as method for expelling pathogenic factors.

During the Sui (AD 589–618) and Tang (AD 618–906) dynasties, massage therapy department was founded within the

Office of Imperial Physicians and the practice and teaching of Chinese massage therapy blossomed. Massage treatment

and the students clinical and theoretical teachings were promoted.

We considered existence of modern Tuina from the time of Dr Sun Si Miao 孙思邈 (AD 590–682). Chinese massage

therapy began to spread to other countries, at first to Japan, where by AD 702 the study of massage became

compulsory for all medical students. At the time China had enormous cultural influences on the civilized world, and

spread culture, science and medicine to other countries including Korea and Vietnam, and via the Silk Trade Route to

the Arabic lands.

During the Ming dynasty 明代 (AD 1368–1644) massage therapy took the name Tuina after two of the most common

manipulations and partly because the term ‘Anmo’ had become associated with prostitution.

During the Qing dynasty 清代 (AD 1644–1912), Tuina continued to develop, but during early 20 century, Traditional

Chinese Medicine began greatly to suffer. Modern medicine promoted by colonial forces were promoted in China, and

TCM at some point almost disappeared.

Between 1912 and 1948, Chinese doctors trained in Japan returned to China and recommended that TCM be abolished.

Such proposal was rejected at the National Medical Assembly in Shanghai on 17 March 1929, therefore this day is

remembered each year and celebrated as Chinese Doctors’ Day.

Mao Ze Dong until Long March of 1934–1935 was against TCM, but due to insufficient medical treatments, drugs, etc.

doctors of TCM came handy, achieving amazing results in treatments of wounded and sick soldiers. In P.R. China from

1948, new Universities of TCM were founded.

In 1956, the first official training course in Tuina was opened in Shanghai, and by 1974 Tuina training departments

had been set up all over China. In 1987, the Chinese National Tuina Asso-ciation was established.

Tuina is very complex subject developed in China, with basic five medical therapeutic schools:

1: One finger meditation school (Yi zhi chan tui fa ⼀指禅推法) emphasizes the stimulation of groups of prescribed

points and sections of channels. It has main function to treat an extensive range of diseases and specializes in treating

headaches, dizziness, insomnia, hypertension, menstrual disorders, digestive problems and lower backache;

2: Rolling school (Gun fa 滚法) The rolling school developed in the 1940s out of the one-finger meditation school.

Techniques are applied to points, along channels and to joints. This school specializes in the treatment of diseases of

the nervous system, all forms of paralysis, headache, joint injuries, chronic joint disease and soft tissue injuries such as

muscle sprains;

3: Point pressure school (An fa 按法) is the oldest school which dates back to ancient shamans and original Chinese

massage therapy. ‘Huang Di Neijing’ states that “pressing can resolve Blood stasis, dispel qi and relieve pain, pressing

produces heat and heat can relieve pain”. It is effective in Qi and Blood regulation, and relieving pain;

4: Striking school (Ji dian fa 击点法) has close connection to Chinese Martial Arts, therefore it is commonly used by

martial arts practitioners in order to treat injuries. It is effective for tonifying Qi and expelling pathogens;

5: Internal exercise school (Neigong 内功) main practice is made in order to train and cultivate inner Qi. It is

connected to Qi Gong, therefore it is required for practitioners to develop the ability to direct Qi along the channels

and inside the patient’s whole body. This method of healing benefits patients in clearing pathogens and strengthening

the immune system.

Training in the TCM Universities in P.R China is based for the most part on a combination of above mentioned five

schools. Chinese massage therapy follows the evolution of humankind and therefore evolves as well with close

connection to the environment and the society's need.

What are the Tuina benefits?

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Tuina successfully can:

promote and invigorate the flow of Qi and Blood;

expel, clear, dissipate and dredge pathogenic factors;

regulate Qi and Blood;

harmonize Yin and Yang;

improve and regulate the functions of the internal organs;

release and relax the channel sinews;

lubricate and facilitate the movement of joints.

What are the common problems treatable by Tuina?

lower backache;

sciatica;

arthritis and rheumatism;

frozen shoulder;

tennis elbow;

wry neck;

carpal tunnel syndrome;

chronic muscular tension and joint restriction;

pain related to old traumas and injuries;

sprains and strains from trauma/sports injuries;

irritable bowel syndrome;

constipation;

diarrhea;

epigastric pain;

abdominal pain;

acid reflux;

belching and flatulence;

hypochondriac pain;

poor appetite.

What does feel it like?

Tuina can be very vigorous and physically active or incredibly subtle and still. It depends on the requirements of

treatment. We can distinguish Yin Style and Yang Style.

Yin Style treatments are very gentle and involve light stretches and manipulation. Breathing and visualization take an

important part of the treatment. It is suitable for internal disease, emotional imbalance and relaxation.

Yang Style treatments involve dynamic strong pressure and manipulations. It is excellent for treating muscular

skeletal complaints.

Tuina and Practitioners ability

For practitioner to be able to apply Tuina techniques, he must be able to make a diagnosis according to TCM principles.

Without this, Tuina has no context and cannot be therapeutically effective. It would be like teaching a calligraphy

student to draw out Chinese characters without meaning.

When Tuina techniques are applied, it creates own particular wave signal. These rhythmic waves and vibrations can

affect the Qi on all levels, traveling through points and along the channels and collaterals to the desired place. The

practitioner’s intention and ability to work with Qi is a powerful therapeutic tool. With the intention formed in the

practitioner’s mind, they can then allow a connection to be made with the unlimited field of healing information

available in the universe. This universal Qi can then be utilized and directed through the practitioner’s hands and into

points, channels, organs, bones and so on.

To become skillful Tuina practitioner it requires long investment in learning and clinical practice. Tuina practitioner

must have deep and profound knowledge of Chinese medicine theory and acupuncture channel system. It is necessary

to be well trained in diagnostics and Tuina techniques in order to create a treatment.

In time Tuina practitioners develop physical strength, flexibility, stamina and coordination. Cultivation of Qi comes in

time, in order to be able to apply Tuina techniques direct Qi through his hands.

What happens during a treatment?

First treatment requires consultations and it's necessary to perform TCM diagnostics as modern medicine diagnostics.

Once information has been gathered to determine the likely causes of your problems, the most appropriate treatment

will then be given.

Tuina can be carried out in the sitting position, lying face down or face up. Before treatment we shouldn't eat at least 1

hour. Tuina is performed through clothes and sometimes a sheet will be used to massage over. You may be asked to

expose the torso or back so that an assessment, if necessary, can be made and sometimes ancillary therapies may be

applied to the skin such as Cupping, Gua Sha, Moxibustion or application of external herbal formula. External herbal

poultices, compresses, liniments and salves are also used to enhance the other therapeutic methods.

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Igor MicunovicDr. Igor Micunovic Ph.D. President of Association of Acupuncturists of Montenegro. World Society

of Traditional Chinese Medicine Societies director board member. Integrative medicine and

personal transformation specialist.

Author profile

1. To become a Tuina practitioner it's not an easy task

2. Tuina is different from other forms of massage with specific emphasis on medical factor

3. To become skillful Tuina practitioner it requires long investment in learning and clinical practice

4. Yang Style treatments involve dynamic strong pressure and manipulations

5. Yin Style treatments are very gentle

6. Tuina practitioner must have deep and profound knowledge of Chinese medicine theory and acupuncture channel system

7. Tuina harmonizes Yin and Yang

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