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Tuina today

Tuina is derived from the Chinese words “Tui” – to push and “Na” – to grasp, two techniques fundamental to traditional Chinese medical massage and manipulation. In present day China, Traditional Chinese Medicine (TCM) is main stream, existing alongside Western medicine and providing for many of the health needs of its massive 1.3 billion plus population.

Tuina is one of the three components of traditional medicine offered in virtually every TCM hospital in that enormous country. Acupuncture and herbal medicine are the other components, both of which Tuina pre-dates. Its full documentation in The Yellow Emperor’s Classics of Internal Medicine shows that 2300 years ago it had already evolved into the highly sophisticated system it is today. The fact that it is still so popular and that most Chinese make recourse to it for the control of chronic pain is sure testimony to its efficiency.

A different theory

Like acupuncture, Tuina is based on classical Chinese medical theory. This places its emphasis on function and wholeness. A body is regarded as complete and therefore healthy if the various intrinsic energies (called “Qi” – pronounced “chee”) are correctly balanced within it at any particular point in time. Even the slightest interruption to the diffusion and flow of qi will manifest itself as illness and pain.

According to the Chinese, the body contains a grid system which contains and controls the movement of qi. Some 2,500 years ago there already existed bronze figures with twelve paired channels or meridians and two unpaired ones embossed on their surfaces. Even at that early date the Chinese had discovered this grid-system and had accurately plotted not only the exact positions of each meridian but also the precise positions of over 300 acupoints or qi-points along them. In recent years, scientists using ultra sensitive measuring equipment, have been able to plot the course of each meridian and locate every qi-point along it. Incredibly, these have confirmed the accuracy of meridian maps included in the Yellow Emperor’s Classics of Internal Medicine!

These meridians can be likened to ocean currents which have position and direction but no observable physical  boundaries. They cannot be exposed by surgery or dissection and do not follow accurately nerves, blood-vessels or muscles. The theory links each of the paired meridians to one of the major (Chinese) organ systems after which it is named, – hence “spleen” meridian, “heart” meridian etc. These organs are very much functional ones. They include at least one (Sanjiao) which has no equivalent in Western medicine and quite often the function ascribed to an organ is quite different from that of the “Western” organ bearing the same name. The “heart,” for example, is believed to house the mind and the “lung” to control skin and hair health by affecting the distribution of qi to them.

The therapy

Tuina is carried out on the clothed body with the recipient seated or lying on a massage couch. The Chinese describe all techniques as “manipulations” but the author restricts this description to those that work with movable joints. Others that treat soft tissues are referred to as “massage” techniques although many differ widely from those used in the likes of Swedish and aromatherapy massage.

The aim of Tuina is to apply movement and pressure to facilitate the flow of qi through the meridian channels and to regulate this with deep stimulation of relevant qi-points. Tuina is not acupressure. The latter is exactly what it says it is, namely deep, static pressure applied to qi-points. Tuina on the other hand, offers the practitioner a diverse range of techniques that are designed to focus pressure with movement both along the meridians and into the qi-points. The subtle variety of direction and force that can be brought to bear on each point is one of the unique features of this massage.

For Tuina to be successful in facilitating qi flow and releasing blockages in this vital energy, the tissues themselves must be amenable to the diffusion of qi. The soft tissue techniques achieve this by loosening the muscle fasciae (connective tissue sheaths enclosing muscle), stimulating lymph flow and blood circulation and affecting tendon organs (tension sensitive sense organs in tendons) so as to improve muscle relaxation.

Every qi-point has an effect on qi movement when it is intensely stimulated with pressure or a needle as in acupuncture. An expert Tuina practitioner will know what combination of these points to use when treating specific problems such as frozen shoulders, sciatica, nausea etc.

Whilst it is true to say that most qi-points can be used to treat problems in their immediate vicinity, many have powerful effects in quite distant parts of the body. For example, qi-point pericardium 6 on the under side of the forearm just up from the wrist has a powerful calming effect and stops vomiting. Qi-point large intestine 4 between first and second metacarpels treats headaches and sinus problems and bladder 60 behind the outer ankle bone (maleolus) treats lower back pain. This means Tuina can treat problems in places where the therapist’s hands cannot reach.


There is no such thing as a full body Tuina massage in China. The Tuina doctor treats just the problem that the patient presents him with, very much like his Western counterpart does. The similarity goes even further. Just as drugs have side effects so does Tuina . . . . but here the similarity ends. Side effects resulting from the Chinese therapy are almost always good ones (except some mild aching or soreness after receiving a first Tuina session). The reason for this is that successful balancing of qi in one area of the body results in improved qi status throughout.

Focusing as it does on specific meridians and acupoints, Tuina is able to treat all those conditions that in the West would be treated by osteopathy, chiropractic and physiotherapy plus a lot of others that would be treated with drug therapies. It excels in the treatment of chronic pain associated with the musculo-skeletal system such as neck and shoulder pain, fibrositis, lumbago, sciatica, muscle spasms, tennis and golfer’s elbow, and frozen shoulder. As a means of treating sports injuries, it is unsurpassed. To this long list can be added chronic problems such as headaches, migraines, constipation, IBS, insomnia, tension and restless mind.

Brilliantly effective as it is, however, Tuina is not a miracle cure-all. It does not treat all migraines effectively. Some require a combination of acupuncture and Tuina. Knee problems are likewise less responsive to the hands on treatment than to acupuncture. In combination, acupuncture and Tuina can often seem to be a means of dispensing miracles! Both work in the same way to create qi balance and both achieve their effects holistically by treating the whole person to help the individual parts function more effectively. The lack of negative side effects or any kind of damaging impact on our seriously threatened environment, makes Tuina as relevant today as it ever has been during its very long history.

Treatments

Although Tuina can sometimes cure even long-standing chronic pain in one session of treatment, Chinese therapists always assume a need for several treatments in quick succession. These all follow a similar pattern which can be summarised as follows:

1. Massage of soft tissues to make them receptive to qi flow

This involves the use of techniques which aid muscle fascia release and stimulate capillary blood flow and lymph drainage. Initially, those techniques that spread the force over a wide area are used. This reduces their penetrative pressure which, if excessive, could be extremely painful at this stage when muscles are still stiff or rigid. Palmar pressing and kneading are often used in this softening-up process together with gentle squeezing done with the whole hand. As the tissues respond, large scale pressing, kneading and squeezing give way to techniques that concentrate force onto smaller areas to increase the pressure exerted. The unique rolling method which uses the knuckles and dorsum of the hand like a rolling pin, is brought into action at this stage. The expert will already be thinking in terms of qi flow and the course of the meridians beneath his/her hand and rolling will be directed along the relevant ones.

2. Boosting qi flow in the meridians

Squeezing, kneading and rolling, is now applied with more vigour along the course of the meridians. Fingers and thumbs, the heels of the palms and even the forearms and elbows are now brought into action to give much deeper penetration. At all times pressure is accompanied by movement – a vast spectrum of it ranging from vibratory, rotational, rocking and percussive to large scale pushing and rubbing. Unlike the traditional Thai massage practitioner who uses a very steady, controlled and unhurried approach, his Tuina counterpart constantly changes the tempo. Some techniques, such as two hand chaffing, are done at lightning speed to generate maximum frictional warming; rolling can be effective at up to 140 rolls per minute and others are performed at very slow speed to facilitate more sustained pressure.

3. Stimulating the Qi-points

At this stage the tissues should be softer and more relaxed and thus able to accept deep penetration. Thumbs and elbows are most frequently used to focus pressure onto specific qi-points. Accuracy is very important here and pressure is once again delivered with movement – usually rocking or rotational. Qi-points that are painful when pressed can indicate some sort of qi blockage. For these, penetration must be progressive and during early treatments may never reach the ideal depth for complete release of qi blockage. It is very interesting, however, to see how quickly most people adapt to this very deep and vigorous type of therapy. Some even become addicted to it! The secret of success does not depend only on pressure but much more on the combination of points used in the therapy. Expert knowledge is required before the right choices can be made with certainty.

4. Manipulations

These are only attempted when all the soft tissue work on the affected area has been completed. So important is the qi balancing process and the attainment of a good degree of muscle and connective tissue release that the first three stages of a treatment will require at least three quarters of the time allocated to it. Manipulations are really effective when all the soft tissue and qi-point work has been thorough. Some Tuina manipulations have a simplicity which belies their effectiveness. The extended arm shake and corresponding leg shake are good examples. In the case of the arm, the practitioner grasps the hand over its dorsum with thumbs just over the top of the wrist to give it mild support. Slight traction is applied and the shake is performed with rapid, small amplitude up and down movements. Apart from stimulating all six arm meridians, this generates a series of rapid, short duration pulls on the shoulder joint – wonderful as part of the treatment to restore mobility to a frozen shoulder.

The success of some manipulations e.g arm rotations, often depends on simultaneous pressing of the appropriate qi-points. The author, after having spent countless hours in TCM hospitals in China, is still amazed at the endless variety and subtle nuances of approach that characterise Tuina manipulations.

The future

In China, even hospitals of Western medicine have departments of Tuina and acupuncture. The author strongly supports the view of that rapidly growing group of people who have experienced its benefits, that these should become available in hospitals in the West. Both Tuina and acupuncture gel into a system of therapy that has no equal.