CHAPTER 1: INTROUDUCTION
I. Knowing the definition of Tuina
II. Understanding the history development of Tuina and the features of the each dynasty
III. Familiarize with the Tuina books which produced during each dynasty and their contributions
IV. Learning the effective way to study Tuina
1.1 Definition of Tuina
Tuina, one of the external therapeutic methods used in TCM, is a study and techniques according to the basic principle of TCM theory (zangfu, meridian, 8-principles) with the combination of human anatomy study.
Tuina is practised and performed by using the practitioner’s hand or certain tools to press or rub certain regions or Acupoint of the patient.
1.2 History
Tuina was developed by Chinese people in ancient times.
Instinct reactions to press the injury area of the body to allay swelling and stop pain when they accidentally hurt themselves during labor.
After years of experience accumulation, people summarized some primitive and effective ways to perform Tuina.
1.2 History
Qin/ HanShangSui/ Tang Song/Jin
Ming/QingR.C
Germination StageGrowing Stage
Peak Stage
1.2 History Development
A form of technique originated from
primitive people, which they pressed
or rubbed when they injured
themselves through physical work
Germination Phase (Shang Dynasty, Qin, Han Dynasty)
Growth and formation (Sui/Tang Dynasty, Song/Jin Dynasty)
The Peak (Ming/Qing Dynasty)
Advance developing (People’s Republic of China)
1.2 History- Germination Stage (Qin and Han Dynasty)
Developments and Dedications
1. First Tuina monograph appeared at the age.
2. System of Tuina was established.
3. Ointment massage was invented and introduced.
4. Practiced physical exercise to cultivate health.
First monograph about Tuina.
《黄帝岐伯按摩十卷》 Huang Di Qi Bo An Mo Shi Juan(Ten Volumes On Tuina Therapies Developed by Yellow Emperor and Qi Bo)
It appeared at the same time with 《黄帝内经》 Huang Di Nei Jing (Yellow Emperor’s Canon of Medicine)
1.2 History- Germination Stage (Qin and Han Dynasty)
1.2 History- Germination Stage (Qin and Han Dynasty)
System of Tuina was already established.
《素问 · 异法方宜论》:“中央者,其地平以湿……其治宜导引按蹻。”
Tuina, originated from Luoyang area in Henan Province (the central region in China )
“ 按” Hand pressing;“ 蹻” Foot stepping
1.2 History- Germination Stage (Qin and Han Dynasty)
Some of the commonly used manipulations has mentioned in 《黄帝内经》 .
Pressing “ 按” Rubbing “ 摩”
Nailing “ 切” Searching “ 循”
Stroking “ 拊” Flicking “ 弹”
Grasping “ 抓” Pushing “ 推”
Bending “ 屈” Stretching “ 伸”
Shaking “ 摇”
1.2 History- Germination Stage (Qin and Han Dynasty)
“ 砭石” Stone “ 刮痧板” Scrapping Plate
1.2 History- Germination Stage (Qin and Han Dynasty)
ToolsRound-head needle and sword-shaped needle are used for Tuina purpose.
1.2 History- Germination Stage (Qin and Han Dynasty)
张仲景 . 《金匮要略》 Jin Kui Yao Lue (Synopsis of Gold Chamber)
•Ointment massage has described as a method for health cultivation.
A powder composed of “ 附子” Fuzi (Radix Aconiti Lateralis) and salt was mentioned to treat headache with Tuina.
Invented the methods of Tuina for saving people who hung themselves
1.2 History- Germination Stage (Qin and Han Dynasty)
华佗 Hua Tuo, famous doctor in late Han dynasty
•Advocated the use of ointment in Tuina.
•First to apply Tuina therapy with ointment to clinical practice.
1.2 History- Germination Stage (Qin and Han Dynasty)
Developed a series of physical exercise known as “ 五禽戏” Wuqinxi (five animals frolics) for health.
The art of the exercise is performed through imitation of 5 different animals’ demeanor.
•Tiger“ 虎”•Deer “ 鹿” •Bear “ 熊”•Ape “ 猿”•Bird “ 鸟”
1.2 History Development
A form of technique originated from
primitive people, which they pressed
or rubbed when they injured
themselves through physical work
Germination Phase (Shang Dynasty, Qin, Han Dynasty)
Growth and formation (Sui/Tang Dynasty, Song/Jin Dynasty)
The Peak (Ming/Qing Dynasty)
Advance developing (People’s Republic of China)
1.2 History- Growing Stage (Sui and Tang Dynasty)
Dedications and Characteristics
1. Tuina department was established in Imperial Hospital.
2. Specialization in Tuina medical affairs.
3. Development of the advocacy of self massage.
4. Systematic development of ointment massage.
1.2 History- Growing Stage (Sui and Tang Dynasty)
Introducing specialists of Tuina in the Imperial Hospital in Sui Dynasty.
In the Tang Dynasty, specialty of Tuina was set up in the Imperial Hospital:
• Tuina worker• Tuina specialist• Tuina doctor
1.2 History- Growing Stage (Sui and Tang Dynasty)
Education of Tuina was introduced and established in Tang Dynasty.
Advocacy of Self-massage:
1. 孙思邈 . 《备急千金要方》 Sun Simiao. Qian Jin Fang (Valauable Prescriptions)
•Promotes methods for self healthcare massage.
1.2 History- Growing Stage (Sui and Tang Dynasty)
2. 巢元方 . 《诸病源候论》 Cao Yuanfang. Zhu Bing Yuan Hou Lun (Treatise on Causes and Symptoms of Diseases)
• Every chapter consists of methods of Health Guidance (Daoyin).
• Specially the methods for rubbing the abdomen.
1.2 History- Growing Stage (Sui and Tang Dynasty)
Systematic development of ointment massage:
1. 葛洪 . 《肘后备急方》 Ge Hong. Zhou Hou Bei Ji Fang (A handbook of Prescriptions for Emergencies)
•First person to systematically study the use of ointment in Tuina.
•证,法,方,药 (Syndrome, Methods, Formulae, Medicine)
•8 prescriptions for preparing ointment for Tuina.
2. 《外台秘要》 Wai Tai Mi Yao (Medical Secrets of An Official)
• Added two more methods: 1. Tuina with salts2. Tuina with decoction
《唐六典》 Tang Liu Dian (Six Canons in the Tang Dynasty)
• Tuina used eight kind of diseases:
Wind, cold, heat, dampness, hunger, overeating, overstrain, easy life.
1.2 History- Growing Stage (Sui and Tang Dynasty)
1.2 History- Growing Stage (Song and Jin Dynasty)
Dedications and Characteristics
1. A more complete monograph of Tuina was seen.
2. Treatments with ointment for Tuina extended to a new height.
3. Tuina was described as one of the sweating therapy.
4. Different methods for reduction was introduced.
1.2 History- Growing Stage (Song and Jin Dynasty)
《圣济总录》 Sheng Ji Zong Lu (Complete records of Holy Benevolence)
• The first complete monograph for Tuina.
• Generalize and summarize the definition of“ 按” An;“ 摩” Mo.
1.2 History- Growing Stage (Song and Jin Dynasty)
《太平圣惠方》 Tai Ping Sheng Hui Fang (Taping Sacred Remedies)
• 6 prescriptions of ointment for treating eye diseases with Tuina were recorded.
• First ointment for massaging the waist was developed.
1.2 History- Growing Stage (Song and Jin Dynasty)
张从正 . 《儒门事亲》 Ru Men Shi Qin (The Scholars’ Care of Their Parents)
• Introducing Tuina manipulation as one of the sweating therapies.
1.2 History- Growing Stage (Song and Jin Dynasty)
《世医得效方》 Shi Yi De Xiao Fang (Effective Formulas Tested by Physicians For Generations)
•Different ways of reduction:
1. Sitting stool climbing ladder “ 坐凳架梯法” (dislocation for shoulder)
2. Reverse hanging“ 倒掉复位法” (dislocation for hip joint)
3. Suspending method“ 悬吊复位法” (spinal fracture )
1.2 History Development
A form of technique originated from
primitive people, which they pressed
or rubbed when they injured
themselves through physical work
Germination Phase (Shang Dynasty, Qin, Han Dynasty)
Growth and formation (Sui/Tang Dynasty, Song/Jin Dynasty)
The Peak (Ming/Qing Dynasty)
Advance developing (People’s Republic of China)
1.2 History- The Peak Stage (Ming and Qing Dynasty)
Dedications and Characteristics
1. Monographs of Infantile Tuina were published.
2. Eight Infantile Tuina manipulations were first introduced.
3. Comprehensive development of adult Tuina field.
4. Advocacy of apprenticeship learning methods.
5. First book describing the development of Tuina.
1.2 History- The Peak Stage (Ming and Qing Dynasty)
1. 《保婴神术》 Bao Ying Shen Shu (Magic Ways to Protect Infants)• The earliest extant Tuina monographs
2. 《小儿推拿全书》 Xiao Er Tui Na Quan Shu (A complete book for Infantile Tuina) • The earliest popular separate edition monograph of Tuina
3. 《小儿推拿广意》 Xiao Er Tui Na Guang Yi (General Introduction to Infantile Tuina)• The most comprehensive Infantile Tuina monograph in Qing
Dynasty
1.2 History- The Peak Stage (Ming and Qing Dynasty)
4. 《幼科铁镜》 You Ke Tie Jing (Iron Mirror of Pediatrics)
5. 《幼科推拿秘书》 You Ke Tui Na Mi Shu (Secret Book on Infantile Tuina)•Most detailed and coherent Infantile Tuina monograph
6. 《厘正按摩要术》 Li Zheng An Mo Yao Shu (Key Manipulations of Authentic Tuina)
• Introduced 8 infantile Tuina manipulations:1. Press “ 按” 5. Push “ 推”2. Stroke“ 摩” 6. Feel “ 运”3. Pinch “ 掐” 7. Knead “ 搓”4. Rub “ 揉” 8. Shake “ 摇”
1.2 History- The Peak Stage (Ming and Qing Dynasty)
Flourishing and comprehensive development of Tuina :
• Bone-setting Tuina “ 正骨推拿”
• Acupoint Tuina “ 点穴推拿”
• One-Finger Tuina “ 一指禅推拿”
• Ophthalmology Tuina “ 眼科推拿”
• Internal Medicine Tuina “ 内科推拿”
• Healthcare Tuina “ 保健推拿”
1.2 History- The Peak Stage (Republic of China)
This stage provides a nexus of teaching for Tuina Development. Different sects and schools of Tuina appeared:
• One-Finger Tuina• Acupoint Tuina• Rolling Tuina• Stomachache Tuina
黄汉如 . 《黄氏医话》 Huang Shi Yi Hua (Huang’s Medical Stories)• First book concerning the development of
Tuina, published in 1933.
1.2 History Development
A form of technique originated from
primitive people, which they pressed
or rubbed when they injured
themselves through physical work
Germination Phase (Shang Dynasty, Qin, Han Dynasty)
Growth and formation (Sui/Tang Dynasty, Song/Jin Dynasty)
The Peak (Ming/Qing Dynasty)
Advance developing (People’s Republic of China)
1.2 History- Advance Developing(People’s Republic of China)
Dedications and Characteristics
1. Comprehensive development period:
i. Excavations and recompile of Tuina monographs.
ii. Introducing Scientific studies for Tuina
iii. System of education in Tuina has been completed.
iv. Scientific studies of Tuina have developed significantly.
v. Remarkable innovations have been made in Tuina.
Excavations and recompile of Tuina monographs
• Classic monographs were collected and published
• Summarize the scientifically and logically from the theory of these Tuina monographs
• Apply western medicine diagnose and anatomic into the practice of Tuina
1.2 History- Advance Developing(People’s Republic of China)
1.2 History- Advance Developing(People’s Republic of China)
Introducing Scientific studies for Tuina
• The theory of syndrome differentiation and treatment are practiced in Tuina.
• Clinical research and scientific methods are performed in Tuina therapy for treating diseases.
1.2 History- Advance Developing(People’s Republic of China)
System of education in Tuina has been completed
• Training classes for Tuina were started in Shanghai Medical School since 1956
• Specialty set up in colleges and universities of TCM in China
• Tuina doctors with master/ doctor degree graduated from universities of TCM
• Essentials of Tuina, Therapeutics of Tuina, Manipulation of Tuina, Exercise for Infantile Tuina – teaching materials
1.2 History- Advance Developing(People’s Republic of China)
Scientific studies of Tuina have developed significantly
• Researchers have studied this specialty with modern science and technology in 1950s
• Data and proof shows that:
i. Tuina can relieve pain according to neurophysiology.ii. Tuina can subdue swelling and revolve stasis. iii. Lower blood pressure and increase 5-HT.iv. Pinching spine promote absorbing functions of small
intestine.
Remarkable innovations have been made in Tuina.
• Ear Acupoint Tuina
• Foot Acupoint Tuina
• Sports Tuina
• Tuina anesthesia
1.2 History- Advance Developing(People’s Republic of China)
Ear Acupoint
Foot Acupoint
1.3 Requirements for Learning Tuina
Familiar with essentials, diagnostics, therapeutic methods for both TCM and WM:i. TCM: Theory of Yin and Yang; five elements;
nutrients/defensive Qi, Qi and blood; etiology; pathogenesis; ;meridians;four diagnostic; eight principles; syndrome differentiation treatment.
ii. WM: Anatomy; physiology; physical diagnostic; motor physiology, nerve sections.
Train up for special physical exercise:i. Practice arduously according to the theory, methods,
exercise
CHAPTER 2: MECHANISM OF TUINA
I. Knowing the mechanism of Tuina.
II. Learn how Tuina therapy can activate blood and resolve blood stasis
Mechanism of Tuina
CHAPTER 2: MECHANISM OF TUINA
Regulating Yin and Yang
Improving deficiency and reducing excess
Activating blood and resolving stasis
Relaxing sinews and dredging collaterals
Regulating sinews for repair
Balance of Yin and Yang
CHAPTER 2.1 Regulating Yin and Yang
Yang “ 阳”Ying“ 阴”
Pathology
•Disharmony of Qi and Blood
•Imbalance of nutrient-Qi/defensive-Qi
Physiology
TuinaMeridians
(Qi and Blood)
Disorder of Yin and Yang
CHAPTER 2.1 Regulating Yin and Yang
The twelve meridians control human life, yet they are the place where diseases can live. If disease starts in the meridians, the physician can use the meridians to treat the root cause of disease.
——Nei Jing
CHAPTER 2.1 Regulating Yin and Yang
Meridians经络
Meridian channel经脉
Associated vessels络脉
It serves as the pathway for the transportation of qi and blood throughout the body, thus connecting the viscera with extremities, the interior with the exterior as well as the upper with the lower.
Meridians integrate the human body into an organic whole.
CHAPTER 2.1 Regulating Yin and Yang
Disorder of Yin and Yang Balance of Yin and Yang
Tuina
Promoting the flow of Qi and blood
Dredging the meridians and collaterals
Reinforcing the tendons and bones
CHAPTER 2.1 Regulating Yin and Yang
Hyper-activity
Intestinal peristalsis
Hypo-activity
Manipulations Recovery
Inhibit
Invigorate
Example:
CHAPTER 2.2 Improving deficiency and reducing excess
Deficiency
Excess
Lack of sufficient substances or hypofunction of an organ
Excessive pathogenic factors or hyperfunction of an organ
CHAPTER 2.2 Improving deficiency and reducing excess
Principle of Improving and Reducing
Stimulation
Frequency
Direction
CHAPTER 2.2 Improving deficiency and reducing excess (Stimulation)
How does Tuina helps?
Adjust such morbid state to improve deficiency and reduce excess by means of normalizing the flow of Qi and blood.
Tuina manipulations
Mild stimulation
Strong stimulation
Physiological functions
Excites
Inhibits
Stimulation
CHAPTER 2.2 Improving deficiency and reducing excess (Stimulation)
Spleen and stomach deficiency
Example: Indigestion
Soft kneading
Mild stimulation
Pishu, Weishu, Zhongwan, Qihai
Gastric and intestinal spasm
Strong knocking
Strong stimulation
Related Acupoints at the back
Stimulation
CHAPTER 2.2 Improving deficiency and reducing excess (Stimulation)
Example: Hypertension
Hyperactivity of liver Yang
Retention of phlegm and dampness
Pushing, pressing, kneading
Qiaogong RegionStrong stimulation
Soft kneading
Mild stimulationPishu, Shenshu
Stimulation
CHAPTER 2.2 Improving deficiency and reducing excess (Stimulation)
Improve Deficiency
Reduce Excess
Mild stimulation
Strong stimulation
Longer time
Shorter time
Stimulation
CHAPTER 2.2 Improving deficiency and reducing excess (Frequency)
Frequency
The change of manipulations within a certain range
The change of manipulations exceeding a certain range
Quantitative
Qualitative
CHAPTER 2.2 Improving deficiency and reducing excess (Frequency)
Example:
One-finger pushing
Normal frequency
High frequency
Dredge the meridians and adjust nutrient-Qi/defensive-Qi
Activate blood to subdue swelling and drain pus to reduce toxin
Frequency
CHAPTER 2.2 Improving deficiency and reducing excess (Frequency)
Frequency
High frequency Concentrated energy Deeper region
Low frequency Diffused energy Surface region
Reducing
Reinforcing
CHAPTER 2.2 Improving deficiency and reducing excess (Direction)
Example:
Abdomen stroking
Clockwise motion
Anti-clockwise motion
Reducing
Reinforcing
Direction
CHAPTER 2.3 Activating blood and removing stasis
Activating blood and removing stasis
Promoting blood flow
Improving blood rheology
Reducing resisitance of blood flow
Improving functions of heart
Promoting the establishment of microcirculation
CHAPTER 2.3 Activating blood and removing stasis
Promoting blood flow
Artery
Veins
Standardize pressure Normal blood circulation
Artery
Veins
Standardize pressure
Fails to maintain
Blood stasis
CHAPTER 2.3 Activating blood and removing stasis
Promoting blood flow
Manipulation force
Pressure of heart Plasticity of wall of vessels
Increase local pressure
Invigorate blood flow
Propel the blood in microcirculation
Activate blood to resolve stasis
Immediate relief of sudden pressure
CHAPTER 2.3 Activating blood and removing stasis
Improving blood rheology
Relationship: Rheology vs Viscosity
Quick blood circulation Low blood viscosity
Slow blood circulation High blood viscosity Blood coagulate
Improving blood rheology
CHAPTER 2.3 Activating blood and removing stasis
How does Tuina helps?
RBC
• Reinforcing number of red blood cells
Lymph
• Elevate the ratio of lymph cells
WBC
•Strengthen the phagocytic function of WBC
CHAPTER 2.3 Activating blood and removing stasis
Reducing resistance of blood flow
Resistance of blood flow Diameter of vessels
Resistance of blood flow Diameter of vessels
Relationship: Resistance vs Diameter
PS: Tuina can relax the vascular smooth muscles and dilate diameter of blood vessels.
CHAPTER 2.3 Activating blood and removing stasis
Reducing resistance of blood flow
Tuina manipulations
Sympathetic nerve Adrenalin Noradrenalin Dilating diameters blood arteryReducing blood flow resistance
lipoid
Reduce resistance of blood flow
Ameliorate lymph circulations
CHAPTER 2.3 Activating blood and removing stasis
Rhythmic beating of heart provides smooth blood circulation
Slowed heart rate
Extended diastolic phase
Increased infusion of blood
Elevated oxygen supply
Reinforced contraction of left ventricle
Manipulation Acupoints: Neiguan, Xinshu
Improving function of heart
CHAPTER 2.3 Activating blood and removing stasis
Promoting the establishment of microcirculation
Vascular net: a major place where blood and tissues exchange substances.
Norm: 8-16% blood capillaries are open.
Tuina therapy
32% blood
capillaries opened
New vascular
net formed
Promote repairing
of wounds/in
juries
CHAPTER 2.4 Relaxing sinews and dredging collaterals
Pathological
Impaired tissueTension and
spasm of muscles
Reduction of blood supply
Accumulation of metabolic
substances
Inflammatory pain and
hyperplasia
Chronic ischemia and hypoxia
Adhesion, fibrosis, scarring of
connective tissue
Tuina Promote the repair of the affected tissue
CHAPTER 2.4 Relaxing sinews and dredging collaterals
Neurology
Muscle spindle receptor
Tendon spindle receptor
Reinforce the contraction of muscles
stimulation
stimulation
Inhibit the contraction of muscles
Motor physiological
•Sufficient extension of affected muscles can excite the tendon spindle receptor
Manipulations for activating joints
CHAPTER 2.4 Relaxing sinews and dredging collaterals
Heat energy
《黄帝内经 》:“按之热气至”
“pressing will cause heat energy to rise”
Tuina manipulations
Temperature elevated
Relieve muscular tension and
spasm
CHAPTER 2.4 Relaxing sinews and dredging collaterals
Analgesic
Tuina therapy
Tranquilize the mind Stop pain Relieve muscular tension and spasm
Increasing pain threshold Reducing stimulation
Relaxing sinews and dredging collaterals
CHAPTER 2.5 Regulating sinews for repair
Dislocation of joints
Dislocation of joints
Dislocation of shoulder joint
Semi-dislocation of articulatio sacroiliaca
Protrusion of lumbar vertebral disc
Pulling shoulder in sitting position
Oblique pulling, stretching and bending the knee
Oblique pulling and stretching the lower limbs
CHAPTER 2.5 Regulating sinews for repair
Transposition of soft tissues
Slipped tendon
Streak-like eminence Severe dysfunction of joints
Flicking, pushing and pulling manipulation
Highlight: Manipulations of broken muscles, sinews & ligaments can only be resorted after operation suture
Regulating sinews for repair
Importance of mechanism of Tuina
• Using the law of syndrome differentiation of treatment to apply Tuina manipulation
• Choose the suitable Tuina manipulation for different diseases
• The patient should feel an immediate positive effect after Tuina
• Acting as an immediate remedy with the absence of medicine or acupuncture
• A healthcare method can be practiced wisely and correctly by individual