CHAPTER 10 Introduction to Section Three

This section of the book focuses on how to apply Tui na in the treatment of disease. One of the big challenges for Tui na practitioners is making choices: choices about which techniques to apply and how to apply them, choices about which channels, points and parts of the body to work on, in which order and for how long.

I believe it is essential to teach students how to create their own Tui na treatments and develop their own style of practice rather than just following prescribed treatment recipes. If you can apply your knowledge of Chinese medicine, channels and points together with your knowledge of the therapeutic actions of the Tui na techniques and the various approaches to their application, then you will be able to plan a Tui na treatment for any ailment that you are likely to see in practice.

In this section you will find the general principles of Tui na treatment, which can be followed and applied in the treatment of any ailment. The aim is to provide an underlying structure that will help you to create and plan your own Tui na treatments. You will also find aspects of treatment such as working with breath and visualization, nourishing Deficiency and clearing Excess and combining acupuncture and Tui na.

I look at a variety of common complaints and conditions to help illustrate how to formulate and apply Tui na treatments. Each category, for example muscular skeletal ailments, focuses on the key aspects of treatment and provides guidance, tips and suggestions for how you might approach the treatment of common patterns of disharmony. I give suggestions for techniques to consider applying and draw your attention to any important points to bear in mind. Finally, to illustrate how this can work in practice, I have included many examples of Tui na treatments from my own practice (and a couple that have been kindly provided by my colleagues).

Creating a Tui na treatment

During the initial stages of Tui na training there is a lot to learn. Your attention is taken up with learning Chinese medicine theory, channels and points, anatomy and physiology and how to apply the Tui na techniques. You are developing your own strength, flexibility and coordination, and cultivating Qi and learning how to direct it. There comes a point, usually when the techniques are starting to flow quite well, when you begin to think about applying your knowledge and skills to treat disease in real patients. At this point you are likely to have lots of questions about Tui na treatment, such as:

‘If the patient has backache, where should I start the treatment?’

‘My mother has a frozen shoulder on the right – shall I work on both shoulders?’

‘When should I use gua sha?’

Creating Tui na treatments is a challenging and creative process. There are many choices and decisions to be made. Initially, you gather information from your patient through questioning, palpation and observation; then you make a diagnosis. Based on your diagnosis, you decide on a treatment principle and plan, which creates a clear intention and focus for your treatment. The next challenge is to choose the points, channels and areas of the body to treat and which techniques to apply. You also need to remain open to discovering what your hands and heart might discover as you work with your patients.

In Tui na, as with acupuncture, there is no one ‘right’ way. There are many approaches to diagnosis and treatment. I believe that any approach can work if the practitioner resonates with it, has made his or her own sense of it and is both challenged and captivated by it. Some students, particularly those who have been working with various forms of energy work, healing and Qigong are naturally intuitive and want to start work on the patient immediately so they can follow their hands and intuition and make their diagnosis as they go. Others, often those who are already acupuncturists, prefer to work things out on paper before they start treatment; they relish the process of ‘working it all out’, and enjoy working methodically to their plan.

I believe in encouraging students to develop their own style and natural abilities, but good Tui na practitioners need to strike a balance between structure and flexibility, maintaining clarity of intention while keeping an open mind. You need to be able to plan a treatment but also able to improvise if your hands and heart make new discoveries as you work on your patient’s body and with their Qi.

In my experience of teaching Tui na I have found that students need a simple framework that helps them to think through how to create a Tui na treatment. Having a basic structure to work with prevents the student and newly qualified practitioner from feeling overwhelmed, confused and lost in the labyrinth of treatment possibilities. It is important in these early stages of clinical practice to be clear about what you are trying to do before you start the treatment, so that once you begin to treat, you can relax enough to be able to focus on other aspects of treatment such as directing your intention and Qi through the techniques to the desired level.

Planning treatment

To help you to focus your thoughts and work out your treatments, use the case format provided in this chapter (see Fig. 10.1) and work with the treatment tips and general principles of treatment.

Fig. 10.1 Case format.

If you are a professional acupuncturist, shiatsu practitioner or practitioner of another system of bodywork studying Tui na, use your patients’ cases and work out what you would do if you were treating them with Tui na. If you are a Tui na student, I suggest that before you begin your student clinical practice, you start to work out as many cases as possible and practice creating Tui na treatments. Use the cases in this book, use cases from other books, for example Giovanni Maciocia’s books, and use your friends and family members. The more practice you get, the better.

General principles of treatment

The general principles listed below have developed through the clinical experiences of Tui na doctors and practitioners over Tui na’s long history and have proved to increase the curative effects of treatment.

I recommend that during your time in the student clinic and in the early days of developing your professional Tui na practice, you work with these principles and discover for yourself their therapeutic value. For those of you with more experience, it is always useful to return to the basics and refresh your knowledge and practice of Tui na.

Follow the three stages of treatment

A balanced treatment moves through three stages: superficial, deep and back to superficial. These stages or levels of treatment are referred to as adaptive, analgesic and dissipative.

Adaptive stage

Start treatment at the Wei Qi level with relatively superficial techniques applied gently and steadily. The adaptive stage is all about the patient and the practitioner adapting to one another. Introduce the patient to treatment gradually so they can begin to relax and allow the energetic connection between you to occur. It is important to honor the power of that initial touch and contact with the patient’s Qi.

The adaptive stage is an opportunity to remember to relax, soften, regulate your breath and direct your Qi through your heart into your hands with your treatment intention in mind. Techniques like Tui fa and Rou fa make ideal adaptive techniques to start treatment with.

Analgesic stage

From the adaptive stage, begin to move gradually deeper, becoming more penetrating in both your physical application of the techniques and your directed focus of intention and Qi. This is the core of the treatment where you can affect the Ying Qi, Yuan Qi and Blood levels. As the rhythmic waves of the techniques begin to penetrate, the patient becomes more relaxed and can drift down into a place somewhere between wakefulness and sleep. This allows you to work deeply into points, release muscles, tendons and ligaments, stimulate Qi and Blood and dredge channels.

At this stage of treatment, patients may feel strong Qi sensations or what is commonly described by Tui na patients as ‘good pain’. The treatment given at this level helps to relieve pain, which is why I assume it was termed the analgesic stage. Gun fa’s versatility makes it an excellent technique to apply as a smooth link between the adaptive and analgesic stages. Strong techniques like elbow Ya fa and Tan bo fa should be applied in the middle of the analgesic stage.

Dissipative stage

The final stage is about coming back up to the surface to the Wei Qi level, breaking up and dissipating any stagnant or pathogenic Qi that has been released during the analgesic stage. Apply striking techniques such as Ji fa and Pai fa and brisk, light techniques like Ma fa, whisking–sweeping and Ca fa. This stage helps to invigorate the patient and bring them back up into ordinary waking consciousness.

Work distally before locally

Open the channels in the limbs, feet and hands to create a clear passageway for dredging stagnant and pathogenic Qi out of the body. For problems in the upper body, use the arm channels for dredging. For problems in the lower half of the body, dredge through the leg channels. For example, if a patient has lower backache, open up the Bladder channel in the legs and stimulate relevant distal points first, then work on the upper back and gradually move towards the lower back to apply the local work.

If you are treating a Deficient condition, stimulate distal points and work along the relevant arm and leg channels with gentle techniques. For example, if a patient has Lung-Qi Deficiency, work along the Lung channel in the arm and stimulate distal points before doing any work on the chest.

Treat the healthy side first

This is particularly important in the treatment of one-sided pain, atrophy and muscular skeletal problems. By working on the healthy side of the body first, you are initially drawing the patient’s attention to what is healthy. You are affirming and reminding the body of how it is in health and what it can return to. You are also working preventatively; as the channels are bilateral, it is quite common to see a channel sinew problem, for example, moving across the body to affect both sides. If, for example, a patient has tennis elbow on the right, work their left arm first for about half the amount of time you would spend working the affected side on the right.

Putting these general principles together, if a patient has lower backache on the left side, treat distally along the Bladder channel in the calf on the healthy right side first.

Treat the back (Yang) before the front (Yin)

Treating the back affects the whole body through the powerful actions of the channels and points that run through it. Whether you want to tonify Qi, nourish Blood, strengthen the functions of the Zangfu, or release the channel sinews, clear pathogens and move stagnation, Tui na treatment will generally involve some work on the patient’s back.

Working the protected Yang side of the body first allows the patient to relax and yield. If you are treating respiratory, digestive and gynecological conditions, always work the relevant areas and points on the patient’s back before working on the front in the Yin and more vulnerable areas of the chest and abdomen. For example, if a patient has menstrual problems, you would start treatment by working on the Governing Vessel and Bladder channel, stimulating relevant Governing Vessel, Back Shu and Huatuojiaji points and generally working on the lower back, sacrum and hips. You would then work distally in the leg channels before applying any abdominal treatment.

If you are working on a Yang channel sinew muscular skeletal problem, work on the Governing Vessel first which governs all Yang.

Feel, find and follow

If a patient has pain, discomfort or restricted joint movement, the first thing to do is to go to that painful place and touch it, feel it and explore it. Like a Tui na detective, find the Ah Shi points, the areas of tension, holding and restricted movement. Follow these areas of tension, adhesion, holding and so on by continuing to palpate the channel sinews along the course of the muscles, tendons and ligaments. Follow what you feel under your fingers and thumbs until the quality of the connective tissue changes.

Feeling, finding and following is a diagnostic tool as well as a form of treatment. Before any treatment begins it provides precise diagnostic information about the location, extent and nature of the problem and the channel sinews involved. When you arrive at the stage of treatment where you want to work locally, go back to what you felt and found and begin to treat the Ah Shi points, release and stretch the channel sinews, break up the adhesion, free the joints and dredge all of this released stagnation and accumulation out of the body through the Jing Well points. Working in this way you will get very reliable feedback from your hands about changes and releases occurring in the connective tissue and develop highly sensitive palpation skills.

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