CHAPTER 1 Foundations and development of Tui na

A brief history of Tui na

Tui na has a long history with many periods of flourishing and development. The first massage techniques were born instinctively from the needs of the people who were living physically hard lives, exposed to the elements and prone to frequent injuries. They discovered that An (pressing) would stop bleeding and Mo (rubbing) would ease pain and reduce swelling. Evidence from archaeological digs suggests that massage was first practiced over 3000 years ago. Ancient oracle bones and tortoise shells were discovered upon which there are inscriptions that refer to a female shaman known as a Bi who cured people with massage. Medicine was inseparable from ritual life and was directed and developed by the shamans of the time who became the first doctors. Massage became quite sophisticated even in these early times.

In the late Zhou dynasty (700–481BC), texts on the development of Chinese medicine refer to massage or ‘An Wu’, as it was then called. These texts mention various techniques including the compound techniques. There is also mention of a famous Dr Bian Que working with a combination of massage and acupuncture. At the same time there are records of widespread folk use of massage therapy in the writing of the philosophers of the time such as Lao Zi (reputed author of the ‘Dao De Jing’).

A ten-volume work specifically on massage called ‘Huangdi Qibo Anmo Shijuan’ Classics on Massage of the Yellow Emperor and Qi Bo attributed to the Qin dynasty (221–207BC) was the first detailed work of its kind. Unfortunately this classic of massage was lost. It came out at the same time as ‘Huangdi Neijing’ Classic of Internal Medicine of the Yellow Emperor, which mainly recorded the theory of Chinese medicine and the use of acupuncture but did also include several chapters and sections devoted to massage therapy, including descriptions of 12 techniques and their therapeutic effects and clinical applications.

The next important reference to Chinese massage therapy is by one of China’s great medical geniuses, Zhang Zhong Jing (AD142–220) who lived during the later Han dynasty (AD25–220). He was possibly the world’s first medical specialist, having a special interest in febrile diseases. His contribution was to establish the principles of drug combining, one of the great achievements of Chinese herbal medicine. He applied these principles to the use of herbal ointments in massage therapy to increase the therapeutic effects. This process was called Gao mo (ointment massage). Hua Tuo, another famous doctor of the time and China’s first recorded surgeon, mentions Gao mo applied for expelling pathogenic factors that had invaded the Exterior. Gao mo continued to develop and grow in popularity and several texts were written on its uses, including prescriptions for making ointments and the diseases that they could treat.

During the Sui (AD589–618) and Tang (AD618–906) dynasties, massage therapy really started to flourish. A department of massage therapy was founded within the Office of Imperial Physicians and the practice and teaching of Chinese massage therapy blossomed. There was an experienced massage doctor in charge of the daily treatments and teaching who worked with a team of massage practitioners and massage workers. Massage treatment and the teaching of students were promoted. The work done during this time laid the foundations for what would become modern Tui na.

Dr Sun Si Miao (AD590–682) who worked during this period introduced a further 10 massage techniques in his book The Massage of Lao Zi and for the first time systemized the treatment of childhood diseases using massage therapy. One special technique that he pioneered was the application of external herbal media on points to treat and prevent disease in children. In his book Six Classics in the Tang Dynasty he describes the treatment of diseases caused by Wind, Cold, Damp and Heat, Deficiency and Excess, with massage therapy. It was during this period that massage therapy took its place as a medical treatment in its own right alongside acupuncture and herbal medicine.

Also during this period Chinese massage therapy began to spread to other countries, initially to Japan, where by AD702 the study of massage became compulsory for all medical students. Then with China’s strong cultural influences it spread to other countries including Korea and Vietnam and via the silk trade route to the lands of Islam.

In the Song dynasty (AD960–1279) and the Yuan dynasty (AD1280–1368), an intensive analysis of Chinese massage techniques was undertaken and the therapy was further refined. It became the primary form of treatment in the bone-setting and pediatric departments at the Institute of Imperial Physicians. During this time there was much importance placed on analyzing the massage techniques.

The Ming dynasty (AD1368–1644) saw the second great flourishing of massage therapy. It was during this time that it took the name Tui na after two of the most common manipulations and partly because the term ‘Anmo’ had become associated with prostitution. Many texts were written during this period, particularly on pediatric Tui na, which had become hugely popular. Tui na specialists from all over China met to discuss diagnosis, techniques and treatments.

During the Qing dynasty (AD1644–1912), Tui na continued to develop and thrive in both imperial and public domains.

In the early part of the 20th century, traditional Chinese medicine (TCM) began to suffer greatly. This was due to competition from the mainly symptomatic treatments of Western medicine now available. There was, in fact, a time when it looked like TCM would die out completely. Between 1912 and 1948, during the rule of Guo Min Dang, doctors trained in Western medicine returned to China from Japan and recommended that TCM be banned. Fortunately, this was rejected at the National Medical Assembly in Shanghai on 17 March 1929, thanks to massive lobbying. This day is remembered each year and celebrated as Chinese Doctors’ Day.

However, the battle was not over. Mao Ze Dong was also against TCM until the Long March of 1934–1935. There were no drugs, anesthetics or surgery available, and doctors of TCM came to the rescue, achieving amazing results with vast numbers of wounded and sick soldiers.

From this time on, TCM had its feet planted firmly on the ground of modern medicine and, under the People’s Republic of China established in 1948, all departments of TCM were nurtured and encouraged to grow. In 1956, the first official training course in Tui na was opened in Shanghai; other hospitals followed suit and by 1974 Tui na training departments had been set up all over China. By 1978, whole hospitals were devoted to the practice of TCM and all other hospitals held within them special TCM departments. International training centers for TCM were established in Beijing, Nanjing, Shanghai, Anhui, Zhejiang and Shandong. In 1987, the Chinese National Tui Na Association was established which holds regular meetings for Tui na doctors to share their clinical experiences and offer papers on their work.

The UK Register of Tui na Chinese Massage has recently been set up in order to promote high standards of training and practice, to encourage practitioners to share their experiences of applying Tui na in the treatment of Western patients and to promote the development and public awareness of Tui na in the UK.

The famous schools of Tui na

Many different schools of Tui na developed in China, each with its own particular style, strength and therapeutic effects. As with Qigong, numerous forms of Tui na developed within particular families and communities, especially in the remote areas of China. These family styles developed from the health needs of the local people and were passed down originally by the local shamans and then through families for generations.

Out of the many and varied approaches, five Tui na schools became particularly famous. These five schools, all of which have had a significant influence on the application of modern Tui na, are:

1. Yi zhi chan tui fa: one-finger meditation school

2. Gun fa: rolling school

3. An fa: point pressure school

4. Ji dian fa: striking school

5. Neigong: internal exercise school

Yi zhi chan tui fa: one-finger meditation school

This school originated and developed in the Qing dynasty (1644–1911). It uses Yi zhi chan tui fa as the primary technique and makes use of a further 11 supporting techniques which are: Na fa (grasping), An fa (pressing), Gun fa (rolling), Mo fa (round rubbing), Nian fa (holding–twisting), Cuo fa (rub rolling), Tui fa (pushing), Rou fa (kneading), Yao fa (rotating), Duo fa (shaking) and Ma fa (wiping).

The techniques are applied powerfully but softly and are penetrating in their effect. The chief manipulation is difficult to learn and master so great attention and importance are given to basic training exercises, Shaolin sinew changing Qigong and continuous practice of the difficult techniques on rice bags.

This school emphasizes the stimulation of groups of prescribed points and sections of channels. It is used to treat an extensive range of diseases and specializes in the treatment of ailments that are related to internal disharmonies such as headaches, dizziness, insomnia, hypertension, menstrual disorders, digestive problems and lower backache.

Gun fa: rolling school

The rolling school developed in the 1940s out of the one-finger meditation school. The primary technique applied is Gun fa (rolling) and the supportive techniques are Na fa (grasping) and the compound versions of Na fa, An fa (pressing), Nian fa (holding–twisting), Cuo fa (rub rolling) and Rou fa (kneading). Techniques are often coordinated and applied simultaneously with passive movements of the joints. Techniques are applied to points, along channels and to joints. The training required is the same as for the one-finger meditation school. Rolling produces a soft rhythmic stimulation of the body; it has a large manipulating area and a powerful ability to move Qi. This school specializes in the treatment of diseases of the nervous system, all forms of paralysis, headache, joint injuries, chronic joint disease and soft tissue injuries such as muscle sprains.

An fa: point pressure school

This is the oldest school, originally developed by the ancient shamans and strongly linked with the practice of folk medicine throughout the historical development of Chinese massage therapy. A reference from the ‘Huang Di Neijing’ states that ‘pressing can resolve Blood stasis, dispel qi and relieve pain, pressing produces heat and heat can relieve pain’.

The primary technique employed is An fa (pressing), which is often combined with Rou fa (kneading) or applied as the compound technique pushing–pressing. Zhen fa (vibrating) and Na fa (grasping) are used as supportive techniques.

This school emphasizes the stimulation of points and channels with pressure that is applied with the thumbs, fingers, elbows, palms and forearms. It has a wide therapeutic range and is effective for regulating the flow of Qi and Blood, dredging the channels, harmonizing and tonifying the Zangfu, dispersing Cold and stagnation of Qi and Blood and relieving pain.

Ji dian fa: striking school

This school, which is particularly popular in the Shandong province, is linked with traditional Chinese martial arts and evolved from the An fa point pressure school.

The primary technique is Ji dian fa (digital striking). The supportive techniques employed are Pai fa (knocking), Ji fa (chopping), An fa (pressing) and compound versions of Na fa (grasping). The application of the techniques is swift and energetic.

Practitioners have to develop strong fingers and arms and good supporting power from the legs to practice this form. It is commonly used by martial arts practitioners to deal with injuries and to correct the flow of Qi. This form is effective for dredging channels, promoting the flow of Qi and Blood, regulating Wei and Ying Qi, tonifying Qi and expelling pathogens.

Neigong: internal exercise school

The emphasis of training is on the cultivation of internal Qi. Practitioners train in Shaolin internal Qigong and develop the ability to direct Qi along the channels and inside the patient’s body. The primary technique is Tui fa (pushing) and this is supported by a variety of other techniques, especially Zhen fa (vibrating); compound versions of Rou fa (kneading) and Na fa (grasping). Techniques are performed in the typical Northern Chinese style: vigorously, powerfully and briskly; but within their application is softness and smoothness. Gentleness (Yin) and strength (Yang) are equally balanced.

The approach of the internal Qi school is always to treat the whole body. Techniques are applied in routine sequences that cover the head, face, back, chest, abdomen and the four limbs. The routine is altered subtly according to the individual patient’s patterns of disharmony.

This school specializes in the treatment of internal disharmony, nourishing the Zangfu, clearing pathogens and strengthening the Wei Qi.

The influence of all of these schools can be seen in the practice of Tui na today. Training in the TCM colleges in China is based for the most part on a combination of the one-finger meditation, rolling and Neigong schools.

Chinese massage therapy has always evolved with the times, the environment and the health needs of the people. In the West, the training and practice of Tui na is continuing to develop and evolve to suit the health needs of Western patients. Practitioners in the West need a flexible approach to deal with the demands of the times. This has led to the beginnings of a further integration of aspects of the five famous Chinese schools, some approaches from the family systems and the blending of Yin and Yang styles.

How Tui na works

Tui na has the ability to:

• Promote and invigorate the flow of Qi and Blood

• Expel, clear, dissipate and dredge pathogenic factors

• Regulate Qi and Blood

• Harmonize Yin and Yang, Wei Qi and Ying Qi

• Nourish, tonify, strengthen and support Qi and Blood, Yin and Yang

• Improve and regulate the functions of the Zangfu

• Release and relax the channel sinews

• Lubricate and facilitate the movement of joints

• Soothe Qi and calm the Shen

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