Tuina, A TCM Technique To Bring About Chi Balance

Gleaned from two Chinese words Tui (to push) and Na (to clutch), Tuina is a traditional Chinese medicine technique that involves manipulation and clinical massage. In China today, Traditional Chinese Medicine (TCM) is a standard medical system that is used side by side with Western medicine helping provide the healthcare needs of the vast population of China.

Practically every TCM hospital in China practices Tuina, which is one of the three branches of traditional medicine practiced in that enormous country. The other branches are herbal medicine and acupuncture, both of which are much older than Tuina. According to the Yellow Emperor’s Classics of Internal Medicine written 2,300 years ago, Tuina had already developed into the highly advanced system it is today. The proof of its efficiency is its extreme popularity to the Chinese people even today as a go to treatment for the relief or management of chronic pain.

Another Theory
Tuina, like acupuncture, is grounded on classical Chinese medical theory. This implies its priority is in wholeness and function. The human body is seen as complete and it is only healthy if the different internal energies (called "Chi") remain properly balanced. Pain and illness will manifest at just the slightest disruption to the distribution and movement of chi.

In traditional Chinese medicine, the body has a grid system within itself that controls and contains the flow of chi. As far back as 2,500 years ago bronze figures with two unpaired and twelve paired meridians or channels imprinted on their surfaces already existed. Even at this time, the Chinese were aware of this grid-system in the human body and had not only mapped with pinpoint precision the correct locations of each meridian but also determined the exact location of 300 plus acupuncture points along them. Utilizing extremely sensitive measuring devices, scientists have recently been able to map the pathway of each meridian (energy channel) and position every acupoint along it. Amazingly, these have verified the accuracy of the maps of the energy channels mentioned in the Yellow Emperor’s Classics of Internal Medicine!

These energy channels can be compared to ocean currents that have direction and position but no discernible physical boundaries. They cannot be unveiled by dissection or surgery and do not accurately follow muscles, blood vessels, or nerves. The theory associates each of the paired energy channels or meridians to one of the important TCM organ systems to which it is named after (i.e., heart meridian, spleen meridian, etc.). These organs systems also include a meridian channel (Sanjiao) that has no comparison in Western medicine. Usually, the function attributed to an organ is pretty much different from that of the organ (in Western medicine) holding the same name. For example, the "heart," is presumed to be the place where the mind resides and the "lung" the organ responsible for the health of the hair and skin as it controls the transport of chi to them.

The Treatment
A person undergoing Tuina is not required to undress. He/she is told to lie or seat on a massage couch. Chinese practitioners dub all techniques as "manipulations" but for the sake of clarity, this description will refer to techniques applied to movable joints. Other methods that treat soft tissues are called "massage" techniques although many widely differ from those used in the likes of aromatherapy and Swedish massage.

The objective of Tuina is to apply pressure and movement to promote the movement of chi within the meridians and to govern this movement through deep stimulation of germane acupoints. Tuina and acupressure are not the same. Acupressure applies static deep pressure to acupoints, while in Tuina practitioners exploit various kinds of procedures that are meant to focus pressure with movement both into the acupoints and along the meridians. One of the unique aspects of this massage is the subtle variation of force and direction applied on each point.

In order for tuina to be successful in removing blockages in chi and promoting the movement of this vital energy, the tissues themselves needs to be receptive to the distribution of chi. Procedures applied on the soft tissue accomplish this by affecting the tendons, activating the circulation and flow of blood and lymph, and by freeing the muscle fasciae (connective tissue casings surrounding the muscle) in order to boost muscle relaxation.

The flow of chi can be affected by every acupoint in the body when the point is strongly stimulated with a needle (as in acupuncture) or pressure (as in Tuina or acupressure). When treating problems such as nausea, sciatica, frozen shoulders etc., highly skilled Tuina practitioners will know what acupoint combinations to use

Several potent effects can be experienced when using acupoints that are quite distant to the affected parts of the body although usually, most acupoints used to treat problems are located in their immediate vicinity. The Pc 6 (pericardium 6) acupoint for example, located in the forearm’s underside near the wrist can help cure vomiting and can induce a powerful soothing effect. The large intestine 6 (LI 6) point found between the first and second metacarpals addresses sinus problems and headaches while bladder 60 (Bl 60) posterior to the maleolus (outer ankle bone) resolves lower back pain. This suggests that Tuina may be able to treat problems in areas of the body where the hands of the therapist cannot reach.

You will never find a full body Tuina massage offered in China. Very much like his Western counterpart, a Tuina practitioner just addresses the issue that the patient presents with. This similarity extends to other areas – Tuina has certain side effects just as medications have. But the side effects produced by this therapy are more oftentimes positive and beneficial (apart from the soreness and/or mild aching after undergoing your first Tuina treatment). This is because the proper balancing of vital energy in one part of the body leads to better chi movement throughout the body.

The results of Tuina’s effects on the acupoints and meridians enables it treat all the conditions that physiotherapy, chiropractic, and osteopathy and other forms of alternative treatments can address and sometimes can be resolved with drug therapies. Tuina is an ideal treatment for chronic pain related the musculoskeletal system such as frozen shoulder, golfer’s or tennis elbow, muscle spasms, sciatica, lumbago, fibrositis, and shoulder and neck pain. Its ability to treat sports injuries is unequalled. Restless mind, tension, insomnia, IBS, constipation, migraines, headaches, and other chronic illnesses can be added to this long list.

However, despite its extraordinary effectiveness, Tuina is not a cure-all that can produce miracles. It may not be an adequate remedy for all types of migraines. Some necessitate a combination of Tuina and acupuncture. Knee conditions likewise may not respond well to manipulative therapy compared to acupuncture. But more often than not, tuina combined with acupuncture may often seem to be a way of administering miracles! Tuina and acupuncture work together to bring about chi balance in a holistic manner by treating the whole individual to help the various body parts function more efficiently. The harmful impact on our seriously endangered surroundings and the very negligible side effects of tuina makes this therapy as relevant today as it ever has been during its ancient multi-millennial history.

Treatments
Chinese practitioners constantly expect a need to provide multiple tuina treatments in rapid succession although tuina can occasionally cure even long-term chronic pain in one treatment session. They all follow a same pattern that can be summed up as follows:

1. Soft tissue massage that promotes receptivity to the movement of chi – This entails techniques that increase lymph drainage and capillary blood flow and assist muscle fascia release. At the onset, techniques that distribute the force over a broad area are used. This lowers their penetrative pressure which, if administered excessively, could be very painful at this point when muscles are still rigid or stiff. Palmar kneading and pressing are commonly used in this softening-up stage along with gentle squeezing done using the entire hand. Other techniques replace the large scale squeezing, kneading, and pressing as the tissues respond. These techniques concentrate force onto smaller parts to add to the exerted pressure. The distinct rolling procedure that makes use of the dorsum and knuckles of the hand, like a rolling pin, is brought into action at this point. An experienced therapist will already be thinking in terms of chi movement and the direction of the energy channels beneath his hand and rolling will be coursed along the pertinent ones.

2. Increasing the flow of chi in the meridians – Rolling, kneading, and squeezing is now administered with more force along the meridian pathways. The heels of the palms, thumbs, fingers and even the elbows and forearms may be utilized to provide a greater far reaching penetration. Pressure is supplemented by movement at all times – a wide gamut of it ranging from percussive, rocking, rotational, and vibratory, rocking to extensive rubbing and pushing. Not like your average Thai massage practitioner who applies an unhurried, controlled and very steady approach, a Tuina therapist changes the tempo constantly. Two hand chaffing and some other techniques are performed in a very fast manner to produce the greatest frictional warming possible.

3. Stimulating the Acupuncture Points – The tissues at this point should by now be more relaxed and softer and thus ought to be amenable to deep penetration. The tools most frequently used are the elbows and thumbs to concentrate pressure onto specific acupoints. Precision is extremely critical here and once again, pressure is delivered with movement – usually rotational or rocking. Points that are painful when pressed can suggest some type of chi obstruction. For conditions like these, in order to achieve total release of chi obstruction, penetration must be progressive. However, it is quite intriguing to see how fast people adjust to this vigorous and very deep form of treatment. Some find it so soothing they go for treatment on a regular basis. Finding the right combination of acupoints rather than relying only on pressure is the secret of success of this treatment. Determining the right combination to be made however requires expert knowledge.

4. Manipulations – They are only performed when all the work on the soft tissue on the problematic part of the body has been done. The achievement of a good degree of connective tissue and muscle release and the balancing of chi is so important that the three initial stages of a therapy will require at least, 75 percent of the time allocated to it. Only when all the acupoint and soft tissue work has been thoroughly performed will manipulations be truly effective. Certain Tuina manipulations have a simplicity that disguises their effectiveness. Perfect examples of this are the extended arm shake and the corresponding leg shake. With regards to the arm, the practitioner grips the hand over its dorsum with his thumbs just over the wrist’s top to provide it mild support. Minimal traction is used and the shake is applied with small, rapid up and down range of motions. Besides activating all six arm energy channels, this produces a series of short quick duration pulls on the shoulder joint in order to bring back movement to a frozen shoulder.