subject: 2.Practising Exercises for Tuina Therapy (Tuina Liangong) [print this page] 2.Practising Exercises for Tuina Therapy (Tuina Liangong)
In clinical application of the principle of strengthening vital qi to eliminate pathogenic factors, it is advisable to make careful observations and analysis of the conditions of mutual growth and declination, wax and wane between vital qi and pathogenic factors and determine the primary and secondary relations and the order of priority. That is to determine which is put at the first place, strengthening vital qi or eliminating pathogenic factors. Or strengthening vital qi and eliminating pathogenic factors are combined with each other, or strengthening vital qi is done before eliminating pathogenic factors or vice versa. In combination of strengthening vital qi and eliminating pathogenic facotrs, the principle of strengthening vital qi without retaining pathogenic factors and eliminating pathogenic factors with vital qi unaffected should be followed.
Regulating yin and yang
The primary cause of occurrence of disease lies in the breakup of the relative equilibrium between yin and yang,i.e. the normal relationship of growth and declination between yin and yang is replaced by wax and wane of yin and yang. So regulation of yin and yang is also one of the basic principles guiding clinical tuina therapy.
Relative excessiveness of yin or yang refers to the excessive and redundant state of yin or yang pathogenic factors. Excess of yang leads to disorder of yin, and excess of yin results in disorder of yang. In treatment, an approach of lessening the excess or reduction method is used.
Relative deficiency of yin or yang means the deficient state of yin or yang in vital qi, which appears in the form of yin deficiency or yang deficiency. When yin is in a state of deficiency and unable to inhibit yang, asthenia heat syndrome will occur, manifested as hypofunction of yin and hyperfunction of yang. When yang is in a deficient state and unable to inhibit yin, asthenia-cold syndrome will appear, manifested as yang deficiency and yin excess.In syndrome of yin deficiency leading to hyperfunction of yang, treatment of tonifying yin should be applied to inhibit yang. And for syndrome of yang deficiency bringing about cold syndrome of yin, warming yang to inhibit yin is used. If yin and yang are both in deficiency, invigorating yin and yang is applicable.
Treatment of diseases in accordance with seasonal, environmental and individual conditions
This therapeutic principle means that in treatment of a disease an appropriate therapeutic remedy should be adopted according to different seasonal and local conditions, physique, sex and age of an individual. This is because occurrence and development of a disease are affected by many factors, such as seasons, climate, geographicenvironment, especially by constitutional factors of an individual. Therefore, in treating a disease, all factors contributing to it must be taken into consideration, a concrete analysis of concrete conditions must be made and different conditions are dealt with in different ways, thereby working out a proper therapeutic method.
In clinical practice of tuina, special attention should be paid to the principle of treating diseases in accordance with individual conditions, by which different treatments are selected according to age, sex, physique, different living modes of patients. In general, if a patient has a strong physique, the location of manipulation is on the lumbus, buttock and limbs and the pathological changes take place in the deeper areas, manipulations with strong stimulations are performed. When a patient has weak physique or is an infant, the location of manipulation is on the head, face, chest and abdomen, or pathological changes are in the superficial areas, the degree of stimulations should be small. Other factors such as the occupation, working conditions of a patient which may be concerned with the occurrence of some disease should also be taken into account in treatment.
Reinforcement and Reduction of Tuina
That asthenia syndrome requires reinforcement while sthenia syndrome requires reduction is one of the basic therapeutic principles of TCM. Reinforcement is to make up for the deficiency of vital qi. All kinds of treatment,which can supplement the materials lacked in the human body and strengthen the function of a certain tissue, are known as reinforcement. Reduction refers to purging or getting rid of pathogenic factors from the body. Therapeutic methods, which have the direct action of eliminating pathogenic factors in the body or inhibiting the hyperfunction of a certain tissue or organ are called reduction.
Reinforcement and reduction of tuina is produced by stimulations of manipulations. Manipulations are applied to certain parts of the body, which bring about some corresponding changes of qi, blood, fluids, the meridians and viscera, which can reinforce asthenic conditions, reduce sthenic conditions and regulate qi and blood with the result of curing diseases, preserving health and building up human constitution. Therefore, reinforcement and reduction of tuina can be obtained only by combining patient's concrete conditions with strength and directions of manipulations, their directions along or against the meridians,properties of stimulations and parts being treated. Commonly used reinforcing and reducing methods of tuina are as follows.
Reinforcing and reducing methods with light or heavy manipulations
Reinforcing method is manipulations producing mild stimulations. The manipulation is gentle, quick and longterm operation, such as light kneading and pressing,which can promote flow of qi and blood, strengthen vital qi and reinforce asthenia. Reducing method is manipulations producing strong stimulations. This manipulation is heavy, strong and short-term performance with exertion of force changing from mild to heavy, such as heavy pressing and kneading, which can arrest pain and activate blood circulation so as to disperse stagnated blood and mass and relieve swelling to stop pain.
Modern medical research maintains that manipulations with light and weak stimulations can activate and excite physiological function and promote secretion of the glands. For example, for indigestion due to splenogastric asthenia, application of light, mild pushing and grasping manipulations with one-finger to acupoints Pishu (BL 20), Weishu (BL 21), Zhongwan (CV 12), and Qihai (CV 6),etc. with long-term, rhythmic stimulations can invigorate the spleen and stomach with good results. Heavy and strong stimulations of manipulation inhibit physiological function and reduce secretion of the glands. For instance, in the case of gastrointestinal spasm, digital-pressing and pressing manipulations with strong stimulations performed for short time on the corresponding spots on the back of
acupoints Weishu (BL 21), Dachangshu (BL 25), etc. can relieve the spasm.
The above examples indicate that strong stimulation means reduction, while mild stimulation means reinforcement. However, the force of reinforcing and reducing functions produced by powerful or mild stimulations of manipulations varies with the constitution of individuals,threshold value of receiving stimulation of different stimulated parts. In clinic, it is marked off by the stronger or milder extent of aching and distending sensations caused in a patient, which, of course, is only an approximate value.
Reinforcing and reducing methods with manipulations of right or left rotation
There are lots of records about the relationship between direction of tuina and reinforcing and reducing action in medical literature through the ages. It is said in the book Xiao'er Anmojing that nipping the point Pitu (spleen-earth), flexing the finger and rotating it leftward have the effect of reinforcement. And it is also said in the book Youke Tuina Mishu that left rotation means reinforcement, while right rotation is reduction. Though these statements are quoted from works on infant tuina, clinic practice confirms that they are applicable to adults too. The practical operation of this method is to manipulate on a certain part or point with the finger, palm or thenar eminance. Generally speaking, rotating clockwise produces reinforcing effect, and rotating counter-clockwise has reducing action. In abdomen tuina, if the direction of manipulation and the moving direction of the part being treated are both clockwise, which has marked effect of catharsis, this manipulation is known as reducing method. If the direction of manipulation is counter-clockwise and the moving direction of the part being treated is clockwise, which improves the digestive function of the stomach and intestine and has the effect of invigorating the spleen and stomach, this manipulation is referred to as reinforcing method.
Reinforcing and reducing methods with manipulation along or against the meridians
Tuina therapy and acupuncture, though they respectively have their own characters and functions, technologically, are somewhat the same in reinforcing and reducing principles. It says in Neijing that manipulation against the meridians for elimination means reduction, while manipulation along the meridians for strengthening effect means reinforcement. In tuina clinic, for cases in need of promoting smooth flow of qi and blood to supplement vital qi, tuina should be performed along the route of the meridians. For instance, some gynecological diseases, differentiated as asthenia syndrome, are treated by selecting some acupoints from the lower sections of the three foot yin meridians connecting with the diseases and applying long-time, gentle, quick manipulations along the direction of the meridians.
They can also be treated by doing tuina manipulations along the meridians to promote abundance and smooth flow of qi and blood so as to restore the normal functional activities of some debilitated tissues and organs. This is a reinforcing manipulation operated along the direction of qi and also an invigorating therapy. For cases needing promotion of qi circulation and purgation, tuina should be performed against the direction of the meridians. For example, cases differentiated as sthenia-heat syndrome, tuina with heavy or pushing manipulation is performed upward on some points against the direction of the governor vessel, which is related to the disease, to get rid of pathogenic heat in the body. This is a method of reducing excess.
Reinforcing and reducing methods with to-and-fro manipulation
This is a most commonly used method in clinical tuina, which refers to doing various to-and-fro manipulations on points or parts of the body to promote circulation of qi and blood and regulation between yin and yang.
Apart from their heaviness and directions, reinforcement and reduction of tuina manipulation are also closely related to concrete stimulated areas or points. Therefore, in treatment selection of proper treated parts or points according to diseases is also very essential for gaining good results in reinforcement and reduction of tuina.
