TUINA AND HEALTHCARE Mr. CHU I TA 朱奕达医师. I.Knowing the definition of Tuina II.Understanding the history development of Tuina and the features of the each

TUINA AND HEALTHCARE

Mr. CHU I TA朱奕达医师

http://www.singaporetcm.edu.sg/cn/index.php

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)



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


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”


“ 砭石” Stone “ 刮痧板” Scrapping Plate


ToolsRound-head needle and sword-shaped needle are used for Tuina purpose.


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


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.


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- 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.


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


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.


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.


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 (Song and Jin Dynasty)


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.


《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.


《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.


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.


《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- The Peak Stage (Ming and Qing Dynasty)


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. 《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


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”


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- Advance Developing(People’s Republic of China)


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



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.


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


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


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


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


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.


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


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


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


Example: Hypertension

Hyperactivity of liver Yang

Retention of phlegm and dampness

Pushing, pressing, kneading

Qiaogong RegionStrong stimulation

Soft kneading

Mild stimulationPishu, Shenshu

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


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


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



Artery

Veins

Standardize pressure Normal blood circulation

Artery

Veins

Standardize pressure

Fails to maintain

Blood stasis



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



Relationship: Rheology vs Viscosity

Quick blood circulation Low blood viscosity

Slow blood circulation High blood viscosity Blood coagulate



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


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.


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


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


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


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


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


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

Documents

TUINA AND HEALTHCARE Mr. CHU I TA 朱奕达医师. I.Knowing the definition of Tuina II.Understanding the history development of Tuina and the features of the each