WSVMA Annual Conference Tui-na: Chinese Medical Massage Spokane Convention Center Spokane, Washington October 1-3, 2010 Michelle Schraeder, DVM, MEd, FAAVA Mountain Veterinary Hospital, Bellingham, WA Michelle C. Schraeder, DVM, MEd, FAAVA Mountain Veterinary Hospital Bellingham, WA Biography: Dr. Schraeder graduated from The Ohio State University in 1985. Through the International Veterinary Acupuncture Society (IVAS), she is certified in veterinary acupuncture and has completed a three year course in Veterinary Chinese Herbal Medicine, and through the Chi Institute is certified in veterinary Tui-na. Dr. Schraeder became one of first two veterinarians to become a Fellow of the American Academy of Veterinary Acupuncture (FAAVA), which is an advanced acupuncture certification. She obtained a Masters of Education in College and Continuing Education from Western Washington University. Presently she is chair of the IVAS US Education and International Education Committees, an IVAS board member, and a member of the AAVA Advanced Certification Committee. Dr. Schraeder practices integrative medicine, utilizing Traditional Chinese Medicine with conventional medicine, at her clinic in Bellingham, Washington. Contact Email: [email protected] TUI-NA: CHINESE MEDICAL MASSAGE Michelle C. Schraeder, DVM, MEd, FAAVA Mountain Veterinary Hospital, Bellingham, WA Tui-na, Chinese medical massage, is one of the five branches of Traditional Chinese Medicine (TCM), with the others being acupuncture, Chinese herbal medicine, Chinese food therapy, and Tai Chi & Qi Gong. All these branches of TCM incorporate the concepts of the body as an integrated whole (holistic medicine), and the theories of Yin and Yang, five element, and meridian/channel. In translation, “Tui” means push and “Na” means grasp or lift. Tui-na, through massage manipulations that stimulate acupressure points or surface regions of the body, seeks to restore physiological balance in the body via restoring flow to the channels and collaterals, promote blood circulation, and regulate Yin and Yang. By the effect of restoring balance, it increases or decreases the body’s functions to combat either excess or deficiency as appropriate. Through balancing the body, Tui-na also can used as preventative medicine, keeping Qi and blood moving freely, strengthening tendons and loosening muscle, and eliminating fatigue. History of Tui-na and other Oriental massage techniques The earliest and classic writing on Chinese medicine was written about 2500 years ago, the Nei Jing translated as The Yellow Emperor’s Classic of Internal Medicine, and contains chapters on massage. Originally Chinese massage is referred to as An-mo, where “an” means to press and “mo” means to rub. The practice of An-mo spread via trade missions to other countries like Japan and Korea during the sixth century and became the basis of dozens of styles of Oriental bodywork that exist today. The term Tui-na was used for the first time in the Ming dynasty (1368 to 1644 AD). Japanese Shiatsu is a modern derivation (early 1900s) of the traditional Anma massage (the Japanese form of Chinese Anmo). How Tui-na works: TCM theory Tui-na, through specific types of pressure to the meridians or acupressure points, aims to move Qi and Blood and thus bring about pain relief. Qi, in Chinese medicine, is the vital energies of the body. Pain in TCM is commonly looked upon to be from stagnation (lack of movement) of either Qi or Blood. Thus by its manipulations Tui-na tries to move Qi and/or Blood to relieve pain. Qi and Blood stagnation can have other effects on the body than just pain. Qi and Blood stagnation can bring pain, stiffness, emotional stress, anger, frustration, depression, various organ diseases, and masses. Excess emotions and life stresses can affect Qi flow, so by allowing free flow of Qi, one can achieve emotional and physical balance and relaxation for the patient. Disease in TCM results from imbalances. Tui-na works to bring Yin and Yang into balance via tonifying moves for deficiency and sedative moves for excess. Briefly, Yin and Yang are two complementary opposites that describe how things function in relationship to each other and the environment around you. Yin-Yang theory explains the life process of continuous change and transformation, and the aim towards balance. Thus through hands-on body treatment, Tui-na aims to bring the body back into a healthy balance, and be pain-free and disease-free. 1 Tui-na individual techniques The major focus of Tui-na techniques is upon specific painful sites, acupressure points, meridians, and muscles and joints. Each of these techniques has quantity (duration and force) and quality (evenness and softness) aspects to them. The equipment needed is one’s fingers, hand, elbow, or knee. The techniques are grouped here by type of technique (Ping, 1998, 72-91) (Xie): Gliding or Swinging Pushing (Tui fa) • Technique - Fingers, palms, or fists held in various positions are pushed over the skin. • Small Animals - Many animals will react to this technique unless it is preceded by others to relax the animal and its muscles first. Tui-fa is one of the most important techniques to help restructure connective tissue, thus allowing changes to boney alignment as well as freeing the Tendinomuscular Meridians (superficial type of meridian that follows lines of major muscles, muscle groups, tendons, and ligaments) allowing return of normal activities (Xie, 147). Circular Rubbing (Mo fa) • Technique - Finger or palm rubs gently and loosely over the area in a circular motion at about 120 times/minute. • Small Animal - Is a good introductory and safe technique and useful for the very debilitated and geriatric animal. Rolling (Gun fa) • Technique - Hand or wrist is rolled backwards and forward over the skin. • Small Animal - Can use LU 10 (boney point of palm/wrist at thumb base) for smaller animals. • Single Thumb (Yi Zhi Chan): • Technique – Place thumb on area and swing forearm inward and outward to cause the extension and flexion of the thumb joint. • Small Animal - Use of either a thumb or finger to apply pressure based on energy, age, size and species. Picking Up and Squeezing: Pinching (Nie fa) • Technique - The thumb opposes a finger and pinches the treatment area deep but gently and quickly, without the palm making contact with the skin. • Small Animal - A simple technique often taught to owners to do at home on the Du channel and bilaterally on the inner Bladder meridian (Shu points), and also may be applied locally to any area of adhesion and stagnation. Grasping/Pulling (Na fa) • Technique - Grasp forcefully skin and muscle with thumb and fingers and lift. Increase pressure gradually with repeated grasping at site. 2 • Small Animal - By grasping with the thumb and forefinger in opposition, can be used to treat any acupuncture point or Ah shi point. Kneading: Rotary Kneading (Rou fa) • Technique - Move balls of one or two fingers or palm heel in a circular motion so that the hand/finger does not slide over the skin, but pulls it along at about 120 times/minute. Deeper and more penetrating than the circular rubbing of Mo fa. • Small Animal - Good for all species and making friends. Broad Circular Kneading (Yun fa) • Technique - Like Rou fa but using the forearm or elbow to treat a larger area. Warming With Friction: Friction rubbing (Ca fa) • Technique - Rub gently and rapidly back and forth over the skin until patient feels heat without moving underlying muscles. • Small Animal - Useful for Yang-deficient geriatric animals and can be easily applied by animal’s owner at home. Piston Rubbing/Kneading (Cuo fa) • Technique – Using both hands friction rub in opposite directions going back and forth or up and down, like pistons of an engine. If done on a leg, looks like making a bread stick with hands on opposite sides of the leg. • Small Animal - Great for Wei syndrome and paresis/paralysis, and is essential for normal return to function after nervous system trauma. Deep Pressure Strokes: Pressing (An fa) • Technique - Press deeply and forcefully with even and gentle pressure channels or points with a finger or palm. Pressure increased slowly with repetition. • Small Animal - Most Bladder Shu points, Huatuojiaji points, and the acupuncture and Ah shi points in large muscles. Digit Pressing/Knocking (Dian fa) • Technique - Pressing depressions between joints and points with the proximal interphalangeal joint of the middle finger. Compared with An fa, it is a stronger stimulus over a smaller area. • Small Animal - This deep pressure technique is useful for Ah shi points in major muscles but needs to be preceded by preliminary techniques like An fa to determine a pressure level acceptable to the animal. Sustained Pressing (Ya fa) • Technique - Pressing forcefully with sustained pressure with the forearm or elbow. 3 Tapotement: Patting (Pai fa) • Technique – Rhythmical and smooth slapping on surface of body with fingers or empty fist. • Small Animal - For invigoration with care that only the right amount of force is utilized. Beating (Ji fa) • Technique – Beating on body with wrist, side of hand, fingertip, or a stick. • Small Animal – Like Pai fa but is used more than it on small animals, and can use only one digit/finger on the smallest of species. Oscillating: Twirling (Nian fa) • Technique – Hold patient’s toe/finger between thumb, index and middle fingers and twirl back and forth gently and rapidly. • Small Animal - On all paresis/paralysis patients, it is important to apply this technique to each digit, where the Jing Well points lie. Also for lameness issues that arose from digital injury or subluxation. Vibrating (Zhen fa) • Technique – Vibrate rapidly palm or fingers firmly on area while concentrating deeply. Shaking (Dou fa) • Technique – Hold distal end of limb and shake up and down (vs. side to side) continuously, gently and rapidly. May need to support knee/elbow with other hand.