Rolling Coordinated with Wrenching Shoulder of Tuina

Thrusting-wrenching Manipulations of Tuina

1. Manipulation in Sitting Position

The patient is in the sitting position. The practitioner exerts the rolling manipulation on the nape, shoulder and back regions of the suffered side at first. After these regions receive full stimulation of rolling and the local pain and the muscle contraction can be relieved, so the rolling should be coordinated with the wrenching in all directions. The practitioner continually exerts rolling stimulation on the anterior region of the shoulder with the heterolateral hand, puts the contralateral hand that is passed through the armpit on the shoulder to stabilize it; then abducts the shoulder to its painful barrier position and makes a sudden and controlled wrenching to expand the abduction range 3 to 5 degrees while rolling, and loosens it immediatelly (Fig 224). Click to read Myocardiopathy in TCM.

Repeat the movements 3 to 5 times. Then the practitioner exchanges his two hands, delivers the rolling to stimulate the posterior region of the shoulder with the hand that is contralateral to the patient and presses the shoulder from the front of the shoulder with the other hand that goes through the armpit to stabilize it; drives the shoulder to be flexed to its painful barrier position and makes a sudden and controlled wrenching to expand the flexion range 3 to 5 degrees, then loosens it immediately (Fig 225)．

Repeat the above movements 3 to 5 times. Later, the practitioner stands behind the patient, resists against the patient’s back with his knee that is contralateral to the suffered shoulder, holds the hand of the suffered side and put it in front of the chest, and pulls it backward to the painful baner position with the hand that is stretched over the patient’s opposite shoulder, exerts rolling stimulation continually on the laterior portion of the shoulder with the other hand；coordinates with sudden and controlled thrusting to adduct the shoulder to surpass its adductive barrier position 3 to 5 degrees while rolling; loosens the shoulder immediately (Fig 226)．Click to read Chinese medicine Treatment for Myocardiopathy.

Repeat the above movements 3 to 5 times. Next, with the tip of his toe stepping on the chair, the practitioner supports the armpit with a flexed knee, makes the suffered shoulder in abduction and the elbow in flexion；holds the lower end of the upper arm with one hand, exerts the rolling on the anterior region of the shoulder with the other hand; after that, rotates the shoulder to its painful barrier position and wrenches it suddenly and gently to expand lateral rotation range 3 to 5 degrees: loosens the shoulder immediately (Fig 227)．

Repeat the above movements 3 to 5 times. Then, the practitioner exchanges the hands to deliver rolling on the posterior region of the shoulder with the hand that holds the arln formerly and holds the lower portion of the arnl with the other hand to rotate the shoulder medially to its painful barrier position; and then wrenches it suddenly and gently to expand medial rotation range 3 to 5 degrees; loosens the shoulder immediately; finally, coordinates rolling with posterior bending—wrenching of the shoulder. The practitioner holds the heterolateral hand to cause the shoulder joint to be extended posteriorly and rotate medially, the elbow joint to be flexed and the hand dorsum to be kept close to the back of the patient, pulls the handback suddenly and gently to move upward along the back for half height of a spinous process and loosens the shoulder immediately while rolling(Fig．228)．Repeat the above movements 3 to 5 times．Click to read Atrial Fibrillation in TCM.

2. Manipulation in Lying Position

The patient lies in the supine position. The practitioner stands by the suffered side, delivers rolling on the anterior portion of the shoulder with one hand, supports the lower portion of the upper arm to keep the shoulder in abduction and the elbow in leaning against his lumbar; then takes the advantage of the trunk movement to abduct the shoulder to its painful barrier position and makes a sudden and controlled motion to expand abduction range 3 to 5 degrees while rolling; loosens the shoulder immediatelv. Repeat the above movements 3 to 5 times (Fig 229). After that, the practitioner guides the patient in lateral lying position, stands in front of the patient, delivers rolling stimulation on the posterior region of the shoulder with one hand, supports the lower portion of the upper arm with the other hand and puts the elbow against the lumbar: then takes advantage of the trunk novement to flex the shoulder to its painful barrier position, and makes a sudden and controlled wrenching to expand flexion range 3 to 5 degrees: loosens the shoulder immediately. Repeat the above movements 3 to 5 times (Fig 230). Click to read Chinese medicine Treatment for Atrial Fibrillation.

Then the patient is asked to flex his elbow．The practitioner supports the elbow with one hand, delivers rolling on the lateral portion of the shoulder with the other hand: then drives the shoulder to be adducted to its painful barrier position, and makes a sudden and controlled wrenching to expand adductive range 3 to 5 degrees: loosens the shoulder immediately (Fig 231)．

Repeat the above movements 3 to 5 times. The practitioner again holds the lower end of the upper arm with one hand to abduct the shoulder delivers rolling on the armpit with the other hand, abducts the shoulder to its painful barrier Dositmn and makes a sudden and controlled wrenching to expand adductive mnge 3 to 5 degrees; loosens the shoulder immediately (Fig 232) repeat the above movements 3 to 5 times. Later, guiding the patlent to lie in the supine position, the practitioner stands by the rostral side, delivers rolling on the anterior portion of the shoulder wlth one hand,holds the lower portion of the upper arm with the other hand to flex the shoulder to painful barrier position graduallv, then makes a sudden and gentle wrenching to expand flexion range 3 to 5 degrees,loosens the shoulder immediately．Repeat the above movements 3 to 5 times (Fig 233)．Click to read Bradycardia in TCM.

The patient’s posture is kept the same as the"above step. The practitioner stands by the suffered side dellversolling on the anterior region of the shoulder with one hand and holds the lower end of the forearm with the other hand to keep the elbow in flexion and the shoulder in abduction; laterally rotates the shoulder to the painful barrier position and makes a sudden and gentie WTenching to expand lateral rotation range 3 to 5 degrees while rolling; loosens the shoulder immediately．Repeat the above movements 3 to 5 times (Fig 234)．

Finally, the patient is asked to lie in laterallying position. The practitioner holds the wrist of the suffered side to make the shoulder joint be extended posteriorly, rotated medially and the elbow joint flexed as the movement of touching the back while the other hand continually rolls on the anterior region of the shoulder, pulls the hand upward along the back to the painful barrier pos]tlon and makes a sudden and controlled wrenching to increase the height of touching back for half width of a spinous process while rolling. Repeat the above movements 3 to 5 times. Click to read Chinese medicine Treatment for Bradycardia.