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

IntroductionChinese 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 qiand 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 massagedso 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)

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 120-180 b/p/m

• Intensity light to strong

• Penetration deep

• Location thick muscled areas, static or dynamic

• Action promote qi and invigorate xue

• Tools dorsal aspect of hand

• Method roll obliquely from the 5th knuckle towards the root of the thumb, fingers relaxed, hand open

一指禅推法 Yi ZhiChan Tui Fa- One Finger

Meditation




• Location points or channels, static or dynamic

• Action promote qi, invigorate xue and dispel stasis

• Tools radial aspect of thumb, thenar eminance

• Method flex and extend the thumb, taking care not to contact with the knuckles

摩法 Mo Fa –Rubbing


• Intensity light

• Penetration superficial

• Location systematic, dynamic

• Action opens channels

• Tools palmer aspect of hand

• Method circling clockwise or anti-clockwise, with a loose hand

擦法 Ca Fa –Scrubbing


• Intensity moderate


• Location systematic, dynamic

• Action warm channels

• Tools palmer aspect of hand, blade of palm

• Method vigorously rub longitudinally or horizontally, with a firm hand

揉法 Rou Fa –Kneading




• Location ridges, dynamic or static


• Tools palmer aspect of fingers

• Method pinch and squeeze with the finger and thumb pads, using a wide grip

拿法 Na Fa -Grasping


• Intensity strong


• Location ridges, static


• Tools palmer aspect of hand and fingers

• Method clasp the finger pads toward the palm, lift using a narrow grip

按法 An Fa -Pressing




• Location points, static

• Action promote qi, invigorate xue and dispel stasis

• Tools tip of finger/thumb, root of palm, knuckle, fist, elbows, knees

• Method apply firm vertical pressure, optional circling

推法 Tui Fa –Pushing




• Location thick muscled areas, dynamic

• Action promote qi, invigorate xue and disperses stasis

• Tools thumb or finger pads, root of palm, elbow

• Method obliquely apply firm pressure then slide along the surface

击法 Ji Fa –Striking

• Frequency 240-360



• Location thick muscled areas, dynamic or static

• Action promote qi and invigorate xue, relax sinews

• Tools blade of palm, fist, dorsum of hand, cupped hand, crane’s beak

• Method alternately strike in a drumming action with both hands

振法 Zhen Fa –Vibrating




• Location thick muscled areas, static

• Action invigorate xue and dispel stasis

• Tools finger tips, palmer surface of hand

• Method place finger tips/palm vertically over area, thumb pulled in, shake horizontally and longitudinally

搓法 Cuo Fa –Foulageing


• Intensity light


• Location limbs, neck or costal region, dynamic or static

• Action promote qi and invigorate xue, relax sinews

• Tools palmer surface of hand

• Method 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


• Intensity light to moderate


• Location limbs, dynamic or

static

• Action relax sinews

• Tools hand

• Method 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




• Location limbs and neck,

dynamic


• Tools hands

• Method 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




• Location joints, static


• Tools hands, elbows, knees

• Method 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


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 ShaoyangGallbladder & 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: Pressing – Lv13, Gb25, Sp21

Muscular spasm: Pressing – Bl17, 46

Subluxation of vertebrae : Pressing – Gb34, Si3, Sj5

• Rehabilitation

Sash cross on back

Lower Back

• Common Ailments

acute lumbar sprain, disc pathology, arthritis


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 intervertebralspaces, 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 Scrubbing - Gao

Arthritis : Pressing – Du4, Bl23, 57 Pushing - Gao

• Rehabilitation

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

Shoulder

• Common Ailments

tendonitis, a-c joint sprain, frozen shoulder


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 TaiyangSmall 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, SjFoulageing – Co Stretching Rotating Shaking

• Modifications

Tendonitis: Pressing – Co11, 16, Sj5, Gb34

A-C joint sprain: Pressing – Jianqian, Jianneiling

Frozen shoulder: Pressing – Co4, St38 Pushing - Bl41

• Rehabilitation

Health ball rotations on wall, Bamboo cane stretches

Upper Limb

• Common Ailments

tendonitis, carpel tunnel syndrome, rheumatoid arthritis


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 YangmingLarge Intestine, Arm Shaoyang Sanjiao, Arm Taiyin Lung, Arm ShaoyinHeart, 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 Pressing – epichondyle points

Carpel tunnel: Pushing – Pc7, Sj4

Arthritis: Pinching – Shixuan Pressing – baxie, shangbaxe

• Rehabilitation

Health ball rotations, Bamboo cane stretches

Pelvis & Hip

• Common Ailments

sciatica/piriformis syndrome, arthritis, muscular strain


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 ShaoyangGallbladder, 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: Pressing – Jiaji, Bl40, 57, 60, Gb41

Arthritis: Pushing/Scrubbing - Gao

Muscular strain: 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


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 ShaoyangGallbladder, Leg Yangming Stomach, Leg Taiyin Spleen, Leg ShaoyinKidney, 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

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