Tuina (Traditional Chinese Massage)
What is Tuina?
Tuina is a medical method using the arms, hands, fingers, elbows and knees as tools for treating diseases and illnesses. Tuina is also used to protect health and build up body immunity, so that disease can be stopped in its beginning acting as a preventative medical measure, without any side effects. Tuina can sometimes be mistaken for acupressure.
Tuina uses techniques and manipulations to stimulate acupuncture points or other parts of the body surface so as to correct physiological imbalances of the body and achieve curative effects. The effect of Tuina is to disperse and smooth obstructions whilst checking and restraining hyperfunction. Tuina is an important part of Traditional Chinese Medicine (TCM), which also encompasses acupuncture, herbal medicine, nutrition and exercise to treat the whole body, mind and spirit.
In summary, Tuina rectifies anatomical anomalies, alters the inner energy state of the biological system and adjusts the bio-information of the body. For soft tissue injuries, Tuina relaxes muscles and tendons and promotes smooth passage of the channels. It also promotes blood circulation and removes blood stasis.
Tuina techniques and manipulations are rigorous. Patients of Tuina treatments can be seated or may be laid on a treatment couch, whichever is the most comfortable position for both patient and practitioner. Tuina treatments are usually applied on top of loose clothing, i.e. rarely on bare skin, although herbal rubs can be used in conjunction with a Tuina treatment.
Tuina has no adverse side effects, although because it can be a powerful treatment in terms of re-adjusting the functions of the body, some patients may see an increase in frequency of visits to the bathroom, or may feel the build up and release of pressure throughout the body, or may feel slightly sedated immediately after treatment or may develop slight bruising (as blocked energy gets released). A lot depends on the patient and the nature and longevity of the disease being treated. The effects of a typical Tuina treatment, if it hasn’t completely cleared any obstruction, can last up to 3 -4 days.
Tuina may be applied to treat many disorders from soft tissue injuries to many other kinds of ailments such as rheumatic pain, tiredness, lack of energy and any symptoms caused by stress or emotional problems. Tuina is even used for cosmetic purposes such as weight loss and an alternative to botox! Tuina is especially good for adults, infants, sports medicine, general health care for the elderly, rehabilitation and orthopaedics, from which many other complementary therapies have evolved as ‘specialist’ therapies.
Tuina works on the same basic theory as other TCM techniques : “Injury or disease causes blockages in the channels of the body. Blockages cause pain.”
How many times have you massaged your temples to relieve a headache, or rubbed aching parts of your body? See…you’re half way to being a Tuina practitioner already!
The History and Development of Tuina Chinese Massage
In China, Tuina dates back to the remote reign of emperor Huang, during which Tuina was called Anwu. By two thousand years ago, Tuina, called Anmo then, had developed into a widely-used medical means. ‘An’ meaning Press and ‘Mo’ meaning Rub. As time went on, Anmo was used as a term for both medical and pleasurable massage. In 1949, the Chinese government officially recognised the medical benefits of the massage and renamed this aspect to Tuina. ‘Tui’ meaning Push and ‘Na’ meaning Grasp. Tuina was officially incorporated into Traditional Chinese Medicine (TCM) as a medical therapy to be used for problems where acupuncture and herbs were less effective. The term Anmo is still used today as a term for non medical massage.
Tuina is one of the earliest medical forms of mankind and can be seen in the medical history of every old nation all over the world. The behaviour of our forefathers was to rub, press, knead, pound or stamp on themselves or their fellows bodies in order to keep out cold, get rid of discomfort and treat various injuries, continually developing their practical experiences, which gradually became what is now known as a natural therapy. At around 500 AD, the first Tuina specialists appeared, just around the Tang dynasty.
Tuina was so successful, it spread around the globe. Tuina is the basis upon which many modern complementary therapies are based, such as Shiatsu, Acupressure, Baby Massage, Deep Tissue Massage, Sports Massage, Lymphatic Draining to name but a few. Chiropractic and Physiotherapy manipulations are also founded on Tuina techniques.
Today in China, every hospital has a Tuina Department. Patients queue up from 8am every morning and have a huge range of symptoms, from prolapsed discs to frozen shoulder and sciatica, to diarrhoea, high blood pressure, migraines, knee problems, tendonitis, tennis / golf elbow to sun stroke, menstrual problems, fatigue or insomnia. Even more symptoms are treated in the infantile Tuina clinic within the department. Symptoms such as diarrhoea, constipation, vomiting, enuresis, convulsions, common cold, asthma, fever, whooping cough, chicken pox to name a few. Even infantile short sightedness is treated through Tuina massage!
Combining massage with herbal medicine has great benefits. Massage can enhance and speed up the action of herbal remedies, our hands can detect a wealth of diagnostic information and touch adds a deeply compassionate level to the act of healing. Furthermore the liniments, oils etc used in massage provide an additional channel for herbs to work.
The Planetary herbalist will get more from a system of massage based on the same traditional energetic and wholistic principles as their herbal practice. Inevitably we must look to the great civilisations of the East to find such systems. Chinese massage, the subject of this article is a sophisticated ancient but living tradition rooted in Yin-Yang, five elements, qi-blood-fluid etc with a unique power to heal disease rather than simply relax the body and relieve tension.
Chinese massage is closely related to acupuncture in its use of the meridian system and is considered to be effective for a similar range of health problems. However it should not be seen as a poor relation to acupuncture. It is an effective and comprehensive therapy and is regarded alongside herbs, diet, qigong and one of the fundamental arts of Traditional Chinese Medicine.
Massage is of course as old as human kind. However even with this perspective the pedigree of Chinese massage is impressive. There are massage textbooks as far back as the Nei Jing (722-481 BC) the most ancient medical texts. In the Tang Dynasty (618-907 AD) it is recorded that there were 56 massage doctors in the imperial hospital more than the total of herbalist and acupuncturists. Around this time
Chinese techniques were imported to Japan and eventually gave rise to Japanese Shiatsu. Later still Peter Henrik Ling learned from Chinese masters before developing Swedish Massage the origin of Western bodywork.
The development of the Chinese tradition came from the synergy between four groups, doctors who brought the sophisticated medical theories of TCM to massage, martial arts who combined deep experience of qi with great ability to heal injuries, Bhuddist and Taoist adepts who used massage as an essential support to their spiritual yoga and laymen often blind practitioners offering massage for pleasure and relaxation.
Since the time of the Mao Zedong massage has continued to develop absorbing western ideas into the traditional framework. It is widely practised and taught in hospital and medical schools and is an essential part of primary healthcare. The astounding success of China’s athletes and gymnasts is due at least in part to the use old traditional massage in their training. Chinese massage is in fact not a single therapy but encompasses five related and overlapping areas.
Amno, press and rub - massage for rejuvenation and health maintenance. Widely used in the home and in martial arts, qi gong and sports training.
Tuina, push and grasp - sophisticated medical massage used to treat injuries, joint and muscle problems and internal disorders.
Infant Tuina - one of the primary ways the Chinese treat babies and young children. The points and channels used are quite different to the standards ones.
Dian Xue, point press - familiar as acupressure. Uses simple pressure techniques. Very much a home remedy but also used by acupuncturists when needles are not suitable.
Wai Qi Liao Fa, curing with external qi - healing with direct transmission by qigong masters after many years of rigorous training and discipline.
In practice it is the context and objectives which distinguishes these branches. In terms of theory and techniques they have much in common. Central to all of them is the idea that massage affects not only the physical body but also the Qi body (the network of channels and points) and the mental body (emotions, thoughts and spiritual faculties). Since both physical and mental health are dependant on a smooth and abundant flow of Qi, massage can effectively treat all three levels.
Jing Luo theory - the basis of Chinese Massage
Like acupuncture Chinese Massage is based on the theory of jing luo or channels and collaterals. According to this theory the body is networked by a system of pathways which function to transport qi and blood, to regulate yin and yang, to protect against external pathogens and to link the internal organs with the exterior. Blockage of the jing luo causes pain and is intimately connected with all health problems.
Chinese Massage is primarily focused on the jing luo and on xue (acupoints) where qi gathers and can be easily manipulated. Massage techniques are understood to affect the jing luo by:
activating qi and blood ( in the sense of increasing its activity)
regulating qi and blood ( in the sense of dispersing stagnation and guiding counterflow)
dredging the channels ( in the sense of removing external pathogens like cold and damp)
Massage also relaxes the jin ( sometimes mistranslated as tendons, jin actually refers to the function of all soft and connective tissue in relation to movement and flexibility) to ease spasm and increase flexibility and straightens the joints. Both jin and joints closely affect the flow of qi in the jing luo.
What is particularly interesting is that these effects create movement in one form or another. Since in TCM terms pain is simply a lack of free flow of qi and blood, this is why Chinese Massage is such a powerful treatment for pain.
Chinese Massage Techniques
Techniques are at the heart of any system of bodywork. They are what defines its feel and therapeutic qualities. Most textbooks on Chinese Massage list between 30 and 70 shou fa or hand techniques. These cover not only a range of soft tissue techniques, but also many percussion and joint manipulation methods including spinal adjustments similar to Osteopathy, although there are important differences. Some of these shou fa resemble western massage, others are quite unique. For example in gun fa, the back of the hand is rotated rapidly back and forth over the skin with an effect which one of my patient's once described as like a heavy rolling pin.
Broadly speaking shou fa are classified into yin (sedating) and yang (stimulating). However each technique is further classified according the therapeutic principles it achieves. For example mo fa (rubbing) stimulates yang qi, tui fa (pushing) regulates counterflow. The skilled therapist combines these techniques in just the same way a herbalist combines herbs in a formula ensuring that therapeutic principles are achieved with a proper balance of yin and yang. So in a situtation where yin sedating techniques are primarily called for, the therapist will use some yang stimulation to activate qi and blood just as a herbalist adds ginger to a cooling formula.
The massage therapist has other tools to draw on. Shou fa can be applied to particular areas, channels, acupoints or ashi points achieving similar results to acupuncture needles. They can also be applied in different directions. Working with or against the flow of the channels, towards or out from the dan tien, clockwise or counter clockwise, all have different effects.
Equally important is the way the techniques are carried out. Chinese sources say that the shou fa must be gentle and soft yet deep and penetrating. The strokes must br applied rhythmically and persistently. The controlled use of very deep, moving pressure is one of the secrets of Tuina massage. A Tuina therapist might spend the same time on one frozen shoulder as a western masseur would spend on an entire body treatment. The repeated application of a single technique many hundreds of times with deep penetration and qi communication is often termed "finger meditation".
Treatment in practice
Chinese Massage is almost always given on a couch or a stool. In the busy, public clinics of Chinese hospitals treatment is often given through clothing. However some Chinese communities have preserved the older tradition of working on the skin which facilitates qi communication and allows herbal applications.
In anmo massage for relaxation the aim is to give a balanced full body treatment combining yang techniques to expel stagnant qi and activate flow, with yin techniques to calm and relax. A set routine is followed but adapted to the constitution and condition of the receiver. A session can last up to two hours and is a very deep experience particularly if there is strong qi communication.
Tuina massage for specific health problems is based on a full TCM case history using the four examinations to identify a complaint, an underlying pattern and treatment principles. This full logical analysis is what gives Tuina its power and raises it above other systems of massage. Based on the treatment principles specific techniques are combined to treat the presenting complaint and underlying pattern.
Here is an recent example from my own practice. A woman complained of stiff painful shoulders. Diagnosis based on the four examinations revealed cold damp bi syndrome affecting the hand tai yang and yang ming channels with underlying liver and kidney emptiness. Tuina started with gentle but firm kneading arround the shoulder and along the affected channels in the arm to activate the qi and blood. When the area was warm and relaxed, deep persistant techniques were applied to ashi points and acupoints to dredge cold and damp. Next shaking and rotating manipulations were used to open the joints and increase mobility followed by vigorous rubbing using a herbal ointment to warm the channels. Finally soft stroking and external qi projection were used to balance qi and guide the cold damp pathogens down the channels and out.
This woman's symptoms improved considerably after two sessions. Later treatment began to focus more on the back and abdomen to strengthen the liver and kidney. Although I did not prescribe herbs this is a case which would have been well suited to Du Huo Ji Shen Tang.
This example illustrates Tuina's extrordinary ability to treat chronic pain. However the range of problems which can be treated by Tuina is very large. Chinese sources list over 140 medical conditions which respond well. These include not only musculoskeletal problems but many internal diseases. For example in treating abdominal and digestive problems related to Spleen emptiness or Liver stagnation, I have found abdominal Tuina given in combination with herbs to make a crucial difference to the patient's improvement. |
