Anmo Tuina

Anmo Tuina - Chinese Massage

Tyler J. Rowe BTCM-Acu BTCM-Chm Dip-Tn CertIV-Fs Cert-CA Cert-ONM

按 摩 推 拿

Introduction Chinese Massage • 按摩推拿 Ànmó Tuīná ‘Press rub Push grasp’ Eight Branches of Chinese Medicine • 针灸 Zhēnjiǔ - Acupuncture & Moxibustion • 草药 Cǎoyào - Herbal Medicine • 食疗 Shíliáo - Dietary Therapy • 推拿 Tuīná - Massage Therapy • 武术 Wǔshù - Martial Arts • 气功 Qìgōng - Meditation • 风水 Fēngshuǐ - Geomancy • 数术 Shùshù - Astrology

皇帝内经素问 Huángdì Nèijing Sùwèn ‘Yellow Emperor’s Internal Medicine Classic – Simple Questions’ •

Chapter 1 – The Universal Truth ‘In the past, people practiced the Dao, the Way of Life. They understood the principle of balance, of yin and yang, as represented by the transformations of the energies of the universe. Thus, they formulated practices such as Daoyin, an exercise combining stretching massaging, and breathing to promote energy flow, and meditation to help maintain and harmonise themselves with the universe.’

• Chapter 24 – Channel Constituents and Acupuncture Techniques People who are repeatedly startled or traumatised have an obstruction of qi and blood in the channels and collaterals. They can manifest numbness or paralysis of the extremities. One should use tuina, massage, and herb wine in these cases.

皇帝内经素问灵枢 Huángdì Nèijing Língshu ‘Yellow Emperor’s Internal Medicine Classic – Spiritual Pivot’ • •

…the conduct of the movement of qi, by massage, moxibustion, ironing out, needling, fire needling or drinking medicines. - Scroll 7 part 42. The Propagation of Disease The round needle has the shape of an egg. It is used for rubbing and massage, to divide and to separate so as not to injure the muscles and flesh. - Scroll 1 part 1. Of Nine Needles and Twelve Source Points

• •

It is necessary to massage the channels first. - Scroll 1 part 4. Noxious Qi’s Disease It is necessary to first massage the locations for as long a time as there is a resonance in hand. - Scroll 8 part 52. Protective Qi

•

When the channels are shallow, do not needle until the channel has been massaged so that the essence does not come out, then needle. - Scroll 2 part 7. On Governing the Needles To harmonize, press and massage that qi which is excessive in the channels. - Scroll 4

•

part 19. To Qi of the Four Seasons

• •

When the needling is finished, massage to finish the pain at this location. When the needling is finished, massage until it is established that the pain has stopped. - Scroll 5 part 26. Assorted Diseases

针灸甲乙经 Zhenjiu Jiayijing ‘The Systematic Classic of Acupuncture and Moxibustion’ • Throughout the course of their therapy [foot yangming channel sinew], massage should be applied. – Book Two verse 6. Channel Sinews • To treat them [central region excess], cultivation of qi and massage are appropriate. – Book Six verse 2-3. Great Treatise on the Favourable & Unfavourable, Root & Branch of Disease, Physiographic Characteristics, and Configurations & Orientations

• At this juncture [liver bi], massage and acupuncture are indicated… At this point [spleen wind] massage, medication, and ‘fire-branding’ are indicated… At this point [shan conglomeration], massage and medication are indicated. - Book Eight verse1-1. On the transmission of Disease Among the Five Viscera Producing Cold & Heat

• In the case of tugging and tension [in the muscles], one must perform cultivation of qi and massage to promote circulation. – Book Ten verse 1-1. The Contraction of Disease by Yin Causing Bi

Specialities • 痹证学 Bìzhèngxué ‘Arthralgia Syndrome’ (Rheumatology)

• 外伤学 Wàishāngxué ‘External Injury’ (Traumatology) • 正骨 Zhènggǔ ‘Bone Setting’ (Orthopaedics)

Characteristics • Definition – the manual manipulation of points, muscles, bones and sinews with the hand, elbow or knee, for the purposes of alleviating injury and illness, maintaining health, and preventing disease, through stimulation or reduction of the channels and pathways. • Requirements – – – – –

Smoothness Strength Stability Rhythm Flexibility

Functions & Effects Functions • Promote circulation of qi and relieve stagnation • Invigorate xue and dispel stasis • Relax the sinews Indications • Soft tissue injury • Chronic joint pain • Muscular dysfunction & atrophy • Paediatric Illness*

Contraindications • Fracture & Dislocation • Open wounds • Deep Vein Thrombosis • Spinal Manipulation*

Treatment prescription & sequence i. Opening techniques – short duration, superficial, gentle methods

ii. Channel movements – long duration, moderate strength and depth iii. Point manipulations – deep tissue, specific locations & mobilisations

Media & Tools • Cloth – no oil needed, barrier, warmth • Liniments, oils, ointments & plasters • Appliances & devices • Practice bag / rice bag

Structures • 骨 gǔ bones • 经 jīng channels • 筋 jīn sinews • 经筋 jīng jīn channel sinews (灵枢 Língshū ‘Spiritual Pivot’ Scroll 4 part 13)

Jingjin, David Legge (Sydney College Press 2010)

Jingjin, David Legge (Sydney College Press 2010)

Jingjin, David Legge (Sydney College Press 2010)

Jingjin, David Legge (Sydney College Press 2010)

Jingjin, David Legge (Sydney College Press 2010)

Jingjin, David Legge (Sydney College Press 2010)

Diagnosis 气 Qì (Stagnation)

血 Xuè Blood (Stasis)

moving

fixed

generalised

localised

dull

sharp

worse with emotional stress

unaffected by emotions

虚 Xū Empty

实 Shí Full

chronic

acute

aggravated by tiredness

aggravated by stillness

alleviated by rest

alleviated by movement

weakness & flaccidity

stiffness & swelling

enjoys pressure

tenderness

Assessment a) Questioning – location, nature, duration, frequency, radiation, aggravating, relieving b) Observing – alignment/posture, skin colour, vasculation, reproducing pain c) Palpate – passive range of movement, resistance, 扪 mén ‘scan’ temperature, 循 xún ‘go-along’ channels, 按 àn ‘press’ ashi-tender points, 拨 bō ‘pluck’ sinews

滚法 Gun fa – Rolling • • • • • • •

Frequency Intensity Penetration Location Action Tools Method

120-180 b/p/m light to strong deep thick muscled areas, static or dynamic promote qi and invigorate xue dorsal aspect of hand roll obliquely from the 5th knuckle towards the root of the thumb, fingers relaxed, hand open

一指禅推法 Yi Zhi

Chan Tui Fa - One Finger Meditation

• • • • • • •

Frequency Intensity Penetration Location Action Tools Method

120-180 b/p/m light to strong deep points or channels, static or dynamic promote qi, invigorate xue and dispel stasis radial aspect of thumb, thenar eminance flex and extend the thumb, taking care not to contact with the knuckles

摩法 Mo Fa – Rubbing • • • • • • •

Frequency Intensity Penetration Location Action Tools Method

60-90 b/p/m light superficial systematic, dynamic opens channels palmer aspect of hand circling clockwise or anti-clockwise, with a loose hand

擦法 Ca Fa – Scrubbing • • • • • • •

Frequency Intensity Penetration Location Action Tools Method

180-240 b/p/m moderate superficial systematic, dynamic warm channels palmer aspect of hand, blade of palm vigorously rub longitudinally or horizontally, with a firm hand

揉法 Rou Fa – Kneading • • • • • • •

Frequency Intensity Penetration Location Action Tools Method

60-90 b/p/m light to strong deep ridges, dynamic or static promote qi and invigorate xue palmer aspect of fingers pinch and squeeze with the finger and thumb pads, using a wide grip

拿法 Na Fa Grasping • • • • • • •

Frequency Intensity Penetration Location Action Tools Method

1-12 b/p/m strong deep ridges, static promote qi and invigorate xue palmer aspect of hand and fingers clasp the finger pads toward the palm, lift using a narrow grip

按法 An Fa Pressing • • • • • •

Frequency Intensity Penetration Location Action Tools

• Method

1-12 b/p/m strong deep points, static promote qi, invigorate xue and dispel stasis tip of finger/thumb, root of palm, knuckle, fist, elbows, knees apply firm vertical pressure, optional circling

推法 Tui Fa – Pushing • • • • • • •

Frequency Intensity Penetration Location Action Tools Method

4-12 b/p/m strong deep thick muscled areas, dynamic promote qi, invigorate xue and disperses stasis thumb or finger pads, root of palm, elbow obliquely apply firm pressure then slide along the surface

击法 Ji Fa – Striking • • • • • •

Frequency Intensity Penetration Location Action Tools

• Method

240-360 moderate deep thick muscled areas, dynamic or static promote qi and invigorate xue, relax sinews blade of palm, fist, dorsum of hand, cupped hand, crane’s beak alternately strike in a drumming action with both hands

振法 Zhen Fa – Vibrating • • • • • • •

Frequency Intensity Penetration Location Action Tools Method

240-480 b/p/m strong deep thick muscled areas, static invigorate xue and dispel stasis finger tips, palmer surface of hand place finger tips/palm vertically over area, thumb pulled in, shake horizontally and longitudinally

搓法 Cuo Fa – Foulageing • • • • • • •

Frequency Intensity Penetration Location Action Tools Method

120-240 b/p/m light superficial limbs, neck or costal region, dynamic or static promote qi and invigorate xue, relax sinews palmer surface of hand with palms facing inward to the contact area create a rolling action by alternately moving the hands upward and downward

抖法 Dou Fa – Shaking • • • •

Frequency Intensity Penetration Location

• Action • Tools • Method

120-360 b/p/m light to moderate deep limbs, dynamic or static relax sinews hand firmly grasp the extremity with both or one hand (the other hand can support the joint), shake upward and downward

摇法 Yao Fa – Rotating • • • •

Frequency Intensity Penetration Location

• Action • Tools • Method

6-12 b/p/m moderate deep limbs and neck, dynamic relax sinews hands firmly grasp the extremity with both or one hand (the other hand can support the joint), progress the joint through the normal range of movement.

扳伸法 Ban

Shen Fa –

Stretching • • • • • • •

Frequency Intensity Penetration Location Action Tools Method

1-2 b/p/m light to strong deep joints, static relax sinews hands, elbows, knees various passive flexibility exercises depending upon joint

Head & Neck • Common Ailments headache, stiff neck, cervical osteoarthritis • Clinical Manifestations dull ache or sharp pain, rigidity, spasms, tenderness, restricted range of movement, dizziness, light headedness, radiation to the upper limb, parasthesia, neuropathy, photosensitivity, nausea, nasal discharge or congestion, redness, oedema, heat • Assessment observation of symmetry, rotation, flexion, extension and side bending, palpation of Leg Taiyang Bladder, Leg Shaoyang Gallbladder, Arm Taiyang Small Intestine & Arm Yangming Large Intestine

Head & Neck • Main Treatment Sequence Foulageing – neck Kneading & Grasping – neck, Gb20, 21, Bailao One finger meditation - Anmain, Gb20, Bl10, Du16 Rolling – neck & nape Pressing – Anmain, Gb20, Bl10, 60, Du16, Si3,13 Scrubbing – Du14 Stretching & Rotating • Modifications Headache: Kneading – scalp Tapping – scalp Pressing – Taiyang, Co4, Lv3, Bitong, Yintang Stiff neck: Pressing - Gb39, Luozhen Osteoarthritis: Pressing – Bl11 Pushing – Bailao, Bl11 • Rehabilitation Sash rotation, flexion and side bending (passive and resited)

Thoracic Regoin • Common Ailments intercostal strain, muscular spasm, subluxation of vertebrae • Clinical Manifestations dull ache or sharp pain, rigidity, spasms, tenderness, restricted range of movement, radiation to the head and neck or lumbar region, shortness of breath, redness, oedema, heat, dislocation of vertebrae • Assessment observation of symmetry during breathing, rotation, flexion, extension and side bending, palpation of Leg Taiyang Bladder, Leg Shaoyang Gallbladder & Arm Yangming Large Intestine

Thoracic Regoin • Main Treatment Sequence Rubbing – thoracic One finger meditation – Bl, Jiaji, Du Rolling – Bl, Jiaji, Du Pressing – Si13, Bl, Jiaji, Du Grasping – Bl, Du Pushing - Bl, Jiaji Striking– Bl Scrubbing – Bl Foulageing – Costal Stretching • Modifications Intercostal strain: Muscular spasm: Subluxation of vertebrae : • Rehabilitation Sash cross on back

Pressing – Lv13, Gb25, Sp21 Pressing – Bl17, 46 Pressing – Gb34, Si3, Sj5

Lower Back • Common Ailments acute lumbar sprain, disc pathology, arthritis • Clinical Manifestations dull ache or sharp pain, rigidity, spasms, tenderness, restricted range of movement, radiation to thoracic or pelvis and lower limb, parasthesia, neuropathy, weakness, tenderness, redness, oedema, heat or coldness, compensatory curvature deformities, narrowing of intervertebral spaces, vascular congestion, constipation

• Assessment observation of symmetry, rotation, flexion, extension and side bending, palpation of Leg Taiyang Bladder & Leg Shaoyang Gallbladder

Lower Back • Main Treatment Sequence Rubbing – lumbar One finger meditation – Bl, Jiaji, Du, Yaoyan Rolling – Bl, Jiaji, Du Pressing – Bl, Jiaji, Du, Yaoyan Grasping – Bl, Du Pushing - Bl, Jiaji Striking– Bl Scrubbing – Bl, Jiaji, Du, Yaoyan Stretching Rotating • Modifications Lumbar sprain: Pressing – Bl40, 60, Yaoytong Disc injury: Pressing – Bl25, 31-33, 54, Si3 Arthritis : Pressing – Du4, Bl23, 57

Scrubbing - Gao Pushing - Gao

• Rehabilitation Sash assisted four-point core exercises, lumbar and hamstring stretches

Shoulder • Common Ailments tendonitis, a-c joint sprain, frozen shoulder • Clinical Manifestations dull ache or sharp pain, worse at night, rigidity, spasms, nodular masses, tenderness, restricted range of movement, radiation to thoracic, neck, upper limb, parasthesia, neuropathy, atrophy, weakness, joint luxation, swelling, tenderness, redness, oedema, heat or coldness • Assessment observation of symmetry, flexion, extension, internal and external rotation, adduction, abduction, scaption, palpation of Arm Taiyang Small Intestine, Arm Yangming Large Intestine, Arm Shaoyang Sanjiao & Arm Jueyin Pericardium

Shoulder • Main Treatment Sequence Rubbing – shoulder Kneading & Grasping – Co, Sj One finger meditatn – Gb21, Co15, Sj14, Si9-13 Rolling – Co, Si, Sj Pressing – Gb21, Co15, Sj14, Si9-13 Pushing – Co, Sj Striking– Co, Si, Sj Scrubbing – Co, Si, Sj Foulageing – Co Stretching Rotating Shaking • Modifications Tendonitis: A-C joint sprain: Frozen shoulder:

Pressing – Co11, 16, Sj5, Gb34 Pressing – Jianqian, Jianneiling Pressing – Co4, St38 Pushing - Bl41

• Rehabilitation Health ball rotations on wall, Bamboo cane stretches

Upper Limb • Common Ailments tendonitis, carpel tunnel syndrome, rheumatoid arthritis • Clinical Manifestations dull ache or sharp pain, rigidity, spasms, nodular masses, tenderness, restricted range of movement, radiation to shoulder, parasthesia, neuropathy, atrophy, weakness, joint deformity, swelling, tenderness, redness, oedema, heat or coldness • Assessment observation of symmetry, flexion, extension, rotation, adduction, abduction, palpation of Arm Taiyang Small Intestine, Arm Yangming Large Intestine, Arm Shaoyang Sanjiao, Arm Taiyin Lung, Arm Shaoyin Heart, Arm Jueyin Pericardium

Upper Limb • Main Treatment Sequence Rubbing – arm Kneading & Grasping – Lu, Sj, Co One finger meditatn – Co10, 11, Lu3, 5, Pc3, 4, Sj5 Pressing – Co4, 5, 10, 11, Lu3, 5, 10, Pc3, 4, 6, 8, Sj2, 5, 10, Si3, 6, 8, Ht3, 8 Rolling - Lu, Sj, Co Pushing/Scrubbing - Lu, Sj, Co, Pc Foulageing – Lu, Sj, Co Stretching Rotating Shaking • Modifications Tendonitis: Plucking - tendon Carpel tunnel: Pushing – Pc7, Sj4 Arthritis: Pinching – Shixuan

Pressing – epichondyle points Pressing – baxie, shangbaxe

• Rehabilitation Health ball rotations, Bamboo cane stretches

Pelvis & Hip • Common Ailments sciatica/piriformis syndrome, arthritis, muscular strain • Clinical Manifestations dull ache or sharp pain, rigidity, spasms, nodular masses, tenderness, restricted range of movement, radiation to lower back or lower limb, parasthesia, neuropathy, atrophy, altered gait, weakness, swelling, tenderness, redness, oedema, heat or coldness • Assessment observation of symmetry, flexion, extension, rotation, adduction, abduction, palpation of Leg Taiyang Bladder, Leg Shaoyang Gallbladder, Leg Yangming Stomach, Leg Taiyin Spleen

Pelvis & Hip • Main Treatment Sequence Rubbing – hip Kneading & Grasping – Gb, St Rolling - Bl, Gb Pressing – Bl36, 54, Gb29, 30, 34 Pushing – Bl, Gb Striking– Bl, Gb Scrubbing – Bl, Gb Foulageing – Hip Stretching Rotating Shaking • Modifications Sciatic/Piriformis: Arthritis: Muscular strain:

Pressing – Jiaji, Bl40, 57, 60, Gb41 Pushing/Scrubbing - Gao Pressing/Pushing – Bl37, Sp10, 11, St31, Lv8

• Rehabilitation Sash assisted lumbar & hamstring stretch, plum blossom stake rolling

Lower Limb • Common Ailments tendonitis/ankle sprain, plantar faciitis, shin splints • Clinical Manifestations dull ache or sharp pain, rigidity, spasms, nodular masses, tenderness, restricted range of movement, radiation to lower back or limb, atrophy, parasthesia, neuropathy, altered gait, weakness, swelling, tenderness, redness, oedema, heat or coldness, crepitus, vascular congestion • Assessment observation of symmetry, flexion, extension, rotation, pronation, supination, palpation of Leg Taiyang Bladder, Leg Shaoyang Gallbladder, Leg Yangming Stomach, Leg Taiyin Spleen, Leg Shaoyin Kidney, Leg Jueyin Liver

Lower Limb • Main Treatment Sequence Rubbing – leg Kneading & Grasping – Bl, Gb, St One finger meditatn – Bl37, 40, 57, Sp6, 9, 10, Kd1 Pressing – Xiyan, St36, Sp6, 9, 10, Bl37, 40, 57, 60, Gb34, 41, Kd3 Rolling - Bl, Gb, St, Kd Pushing/Scrubbing – Bl, Gb, St, Kd Foulageing – Lv, Gb Stretching Rotating Shaking • Modifications Tendonitis: Pressing – Gb40, St41, Lv4, Kd4 Plucking - tendon Fasciitis: Pressing - Bl61, 62, St43, Sp3,4, 3, Kd2 Grasping Shin splints: Pressing/Pushing – Lv5, Kd7 Striking – St, Lv/Kd • Rehabilitation Plum blossom stake stepping and rolling