A Basic Introduction to Tuina
Overview of Tuina in application to Bodywork
Please note, any discussion of anything to do with Traditional Chinese Medicine is by neccesity a brief overview. You can spend the rest of your life studing Traditional Chinese Medicine and still not even come close to knowing anything about it. Five years of study has been just enough to scratch the surface. That being said, the surface is still darn useful.
What is Tuina?
Tuina is the massage componet of Traditional Chinese Medicine (abbreviated TCM from now on). TCM, like many eastern healing systems consists of four componets. Most of these healing systems include massage of some type, a type of exercise, a nutritional supplement, drug or herbal componet, and a balancing intervention. The four componets in TCM are: tuina, qui gong, herbalism and accupuncture. All these techniques are aimed at one thing: getting chi/qi to flow properly through the body. Chi is purported to be a life force that circulates through the body much like blood. When it is blocked, or stagnant then pain and disease soon follow. Similarly, the concept is that if you free the blockage, or drain out the stagnant chi, then health and freedom from pain follow.
History of Tuina
Tuina history is intimately tied in with TCM history, and TCM history is tied with Chinese History. TCM history starts approximately in the Zhou Dynasty(1027 B.C. - 221 B.C) with the Hung-Di Nei-Jing or Yellow Emperor's Cannon of Internal Medicine. Here is a pretty decent over view. It's certainly better than one I can write, but incomplete. If you are interested, I recomend this link, and this link for a more complete overview (though remember my caution, you could spend the rest of your life studing just the history). At that point in time (Zhou Dynasty) China was not one country and thus the progression of TCM is not a linear one. The idea of a master who divulges secrets to his students prevailed in the Chinese territories until The Cultural Revolution under Mao. At that time, Mao chose to elevate TCM to be on par with Western Medicine. He also chose to standardize it with training, and a common title of The Barefoot Doctor. Although the practice of using these doctors to cover rural areas was discontinued in the 1980's, they generally are throught to have shown how effective such treatment could be. In the 1970's when China and the United States became closer, many chinese imigrated to the United States and the TCM movement in the U.S. gathered steam. From this you have several good books on theory that are accessible to non-chinese that I recomend. The Web that has no Weaver. Voices of Qi also looked accesible.
In the current time, TCM is most present in the U.S. via accupuncture and herbalism. You will rarely find a Doctor of Tuina, or a Doctor of Qi Gong. Mostly lay people like me and Tai Chi instructors fulfill those roles.
Schools of Thought in TCM
Because TCM (and Tuina) were developed non-linearly, there are a few different approaches to issues. The two major schools of thought that I am familiar with are five elemements, and Zang fu. Five elements relys on the cycle between metal, earth, wood, fire, and water. Zang fu relys on the diagnoses and treatment of pathogenic factors (wind, cold, head, damp, phlem, and toxic heat) in relation to their infestation of particular internal organs (Lung, kindney, spleen, Liver, etc.)
How on earth does this have any relation to massage?
The chinese system of medicine is very lyrical. They use words like "a cold-damp infestation of the lungs" to say you have a common cold. Or they will call an injury from years ago in the knee "an unresolved cold-damp invasion." The answer with Tuina is always the same. Whether it damp-cold, or an imbalance in the elements, you use accupressure (different points for different problems) and the methods of percussion, finger springing, pinching, rubbing, hand rolling, eagle talon pulling, and others to break up the stagnant chi that is bogged down in the area. (If chi (qi) confuses you, well, I've said it before, and I'll say it again. You can spend the rest of your life studying it. A full discussion of what chi is, is outside the scope of this page. I recommend this link here.)
Techniques of Tuina
There are many techniques in Tuina, and it would be exhaustive to put them up here in detail. A good book is Tuina Hand Techniques(It used to be available through the taoistsanctuary.org, but they no longer seem to have it). There are classes though of technique that you could expect to find in a strict Tuina session.
- Accupressure point work
These techniques can be done with all parts of the hands, knuckles, and elbows. (The amount of pressure varies depending on where you are performing the technique and what the tissue will allow.)
Evidence for/against Tuina
Rigorus scientific studies are absent on this particular style of massage. If you can read Chinese there are several percentage type studies that have been run in chinese hospitals with no placebo group (a group of people with a particular issue are treated and they will list the percentage helped by the treatment). Since I don't read or speak Chinese I do not have access to these studies. Therefore I must default to studies on the efficacy of massage in general. Most reasearch that is easily available about massage is done at the Touch Research Institute. However, since this reseach is funded by the American Massage Therapists Association, you should take it with a grain of salt (though they have followed accepted scientific study guidelines which is a good step.) Better is the study recently published in The Archives of Internal Medicine on back pain. If you are willing to wade through all the junk advertising and the ideas about legalizing massage therapy, the LA Times has a listing of some of the benefits others have found for massage in the last few years.
Why do I use Tuina in my practice?
No one set of techniques works for everyone. I have Tuina in my bag of possibilities and some of it I use often (Hand rolling especially) and some of it I use rarely. It depends on the session and the client. But I have found that some of the techniques are not only enjoyable to the client, but are extremely effective on certain types of issues. (Long term percussion on the low back is a great tool when applied properly, and I highly recommend it.)
How does Tuina feel?
This is a discussion that doesn't really work in words. Oscilation techniques are always described to me as a gentle rocking that feels "really good." Percussion had been variously described to me as "annoying", "like being inside an engine", or "fantastic!" Similarly I've gotten reports of "hurts so good", "felt great", etc for the other Tuina techniques. And because I've had everything done to me that I do to other people, they are all correct, just maybe not all at the same time. It's like other massage, but less of the long strokes and more invigorating, I think.
When should I NOT have Tuina?
Most of the contraindications that are listed with regular massage apply to Tuina. These in particular:
- Open wounds (local contraindication)
- Broken bones (local contraindication)
- High fever/convusions (general contraindication)
- Heart Failure (general contraindication)
- Some systemic infections. Colds excepted
Please note that some of these things are able to worked around, and some are not. There are some practioners who have specialized in working with some of the above conditions, but I do not feel my training is complete enough.
Index of References
- China Direct
- Taoist Sanctuary
- Touch Research Institute
- Archives of Internal Medicine
- Los Angelese Times
And in addition I used the information given to me in class at Big Sky Somatic Institute. If you would like a link to any of the above sources, please email me.