Transcript 1.2 History Development

TUINA AND
HEALTHCARE
Mr. CHU I TA
朱奕达医师
I. Knowing the definition of Tuina
II. Understanding the history development of Tuina and
the features of the each dynasty
III.Familiarize with the Tuina books which produced
during each dynasty and their contributions
IV.Learning the effective way to study Tuina
1.1 Definition of Tuina
Tuina, one of the external therapeutic methods used in TCM,
is a study and techniques according to the basic principle of
TCM theory (zangfu, meridian, 8-principles) with the
combination of human anatomy study.
Tuina is practised and performed by using the practitioner’s
hand or certain tools to press or rub certain regions or
Acupoint of the patient.
1.2 History
Tuina was developed by Chinese
people in ancient times.
Instinct reactions to press the
injury area of the body to allay
swelling and stop pain when they
accidentally hurt themselves during
labor.
After years of experience
accumulation, people summarized
some primitive and effective ways
to perform Tuina.
1.2 History
1.2 History Development
Germination Phase (Shang
Dynasty, Qin, Han Dynasty)
A form of technique
originated from
primitive people,
which they pressed
or rubbed when
they injured
themselves through
physical work
Growth and formation
(Sui/Tang Dynasty, Song/Jin
Dynasty)
The Peak (Ming/Qing Dynasty)
Advance developing (People’s
Republic of China)
1.2 History- Germination Stage
(Qin and Han Dynasty)
Developments and Dedications
1. First Tuina monograph appeared at the age.
2. System of Tuina was established.
3. Ointment massage was invented and introduced.
4. Practiced physical exercise to cultivate health.
1.2 History- Germination Stage
(Qin and Han Dynasty)
First monograph about Tuina.
《黄帝岐伯按摩十卷》Huang Di Qi Bo An
Mo Shi Juan
(Ten Volumes On Tuina Therapies
Developed by Yellow Emperor and Qi Bo)
It appeared at the same time with 《黄帝内
经》Huang Di Nei Jing (Yellow Emperor’s
Canon of Medicine)
1.2 History- Germination Stage
(Qin and Han Dynasty)
System of Tuina was already
established.
《素问·异法方宜论》：“中央者，其地平以
湿……其治宜导引按蹻。”
Tuina, originated from Luoyang area in
Henan Province (the central region in
China )
“按”Hand pressing;“蹻”Foot stepping
1.2 History- Germination Stage
(Qin and Han Dynasty)
Some of the commonly used manipulations has mentioned
in 《黄帝内经》.
Pressing
“按”
Rubbing
“摩”
Nailing
“切”
Searching
“循”
Stroking
“拊”
Flicking
“弹”
Grasping
“抓”
Pushing
“推”
Bending
“屈”
Stretching
“伸”
Shaking
“摇”
1.2 History- Germination Stage
(Qin and Han Dynasty)
“砭石”Stone
“刮痧板”Scrapping Plate
1.2 History- Germination Stage
(Qin and Han Dynasty)
Tools
Round-head needle and sword-shaped needle are used for Tuina
purpose.
1.2 History- Germination Stage
(Qin and Han Dynasty)
张仲景.《金匮要略》Jin Kui Yao Lue
(Synopsis of Gold Chamber)
•Ointment massage has described as a
method for health cultivation.
A powder composed of “附子”Fuzi
(Radix Aconiti Lateralis) and salt was
mentioned to treat headache with
Tuina.
Invented the methods of Tuina for saving people who hung
themselves
1.2 History- Germination Stage
(Qin and Han Dynasty)
华佗 Hua Tuo, famous doctor in late Han
dynasty
•Advocated the use of ointment in Tuina.
•First to apply Tuina therapy with
ointment to clinical practice.
1.2 History- Germination Stage
(Qin and Han Dynasty)
Developed a series of physical exercise known as “五禽戏”
Wuqinxi (five animals frolics) for health.
The art of the exercise is performed through imitation of 5
different animals’ demeanor.
•Tiger“虎”
•Deer “鹿”
•Bear “熊”
•Ape “猿”
•Bird “鸟”
1.2 History Development
Germination Phase (Shang
Dynasty, Qin, Han Dynasty)
A form of technique
originated from
primitive people,
which they pressed
or rubbed when
they injured
themselves through
physical work
Growth and formation
(Sui/Tang Dynasty, Song/Jin
Dynasty)
The Peak (Ming/Qing Dynasty)
Advance developing (People’s
Republic of China)
1.2 History- Growing Stage
(Sui and Tang Dynasty)
Dedications and Characteristics
1. Tuina department was established in Imperial Hospital.
2. Specialization in Tuina medical affairs.
3. Development of the advocacy of self massage.
4. Systematic development of ointment massage.
1.2 History- Growing Stage
(Sui and Tang Dynasty)
Introducing specialists of Tuina
in the Imperial Hospital in Sui
Dynasty.
In the Tang Dynasty, specialty
of Tuina was set up in the
Imperial Hospital:
•Tuina worker
•Tuina specialist
•Tuina doctor
1.2 History- Growing Stage
(Sui and Tang Dynasty)
Education of Tuina was introduced and
established in Tang Dynasty.
Advocacy of Self-massage:
1. 孙思邈.《备急千金要方》Sun Simiao.
Qian Jin Fang (Valauable
Prescriptions)
•Promotes methods for self
healthcare massage.
1.2 History- Growing Stage
(Sui and Tang Dynasty)
2. 巢元方.《诸病源候论》Cao
Yuanfang. Zhu Bing Yuan Hou Lun
(Treatise on Causes and Symptoms of
Diseases)
•Every chapter consists of
methods of Health Guidance
(Daoyin).
•Specially the methods for rubbing
the abdomen.
1.2 History- Growing Stage
(Sui and Tang Dynasty)
 Systematic development of ointment massage:
1. 葛洪.《肘后备急方》Ge Hong. Zhou Hou Bei Ji
Fang (A handbook of Prescriptions for
Emergencies)
•First person to systematically study the use of
ointment in Tuina.
•证，法，方，药 (Syndrome, Methods, Formulae,
Medicine)
•8 prescriptions for preparing ointment for
Tuina.
1.2 History- Growing Stage
(Sui and Tang Dynasty)
2. 《外台秘要》Wai Tai Mi Yao (Medical Secrets of An Official)
•Added two more methods: 1. Tuina with salts
2. Tuina with decoction
《唐六典》Tang Liu Dian (Six Canons in the Tang Dynasty)
•Tuina used eight kind of diseases:
Wind, cold, heat, dampness, hunger, overeating, overstrain,
easy life.
1.2 History- Growing Stage
(Song and Jin Dynasty)
Dedications and Characteristics
1. A more complete monograph of Tuina was seen.
2. Treatments with ointment for Tuina extended to a new height.
3. Tuina was described as one of the sweating therapy.
4. Different methods for reduction was introduced.
1.2 History- Growing Stage
(Song and Jin Dynasty)
《圣济总录》Sheng Ji Zong Lu (Complete records of Holy
Benevolence)
•The first complete monograph for Tuina.
•Generalize and summarize the definition
of“按”An;“摩”Mo.
1.2 History- Growing Stage
(Song and Jin Dynasty)
《太平圣惠方》Tai Ping Sheng Hui Fang
(Taping Sacred Remedies)
•6 prescriptions of ointment for treating
eye diseases with Tuina were recorded.
•First ointment for massaging the waist
was developed.
1.2 History- Growing Stage
(Song and Jin Dynasty)
张从正.《儒门事亲》Ru Men Shi Qin (The
Scholars’ Care of Their Parents)
•Introducing Tuina manipulation as
one of the sweating therapies.
1.2 History- Growing Stage
(Song and Jin Dynasty)
《世医得效方》Shi Yi De Xiao Fang (Effective
Formulas Tested by Physicians For Generations)
•Different ways of reduction:
1. Sitting stool climbing ladder “坐凳架梯法”
(dislocation for shoulder)
2. Reverse hanging“倒掉复位法”
(dislocation for hip joint)
3. Suspending method“悬吊复位法”
(spinal fracture )
1.2 History Development
Germination Phase (Shang
Dynasty, Qin, Han Dynasty)
A form of technique
originated from
primitive people,
which they pressed
or rubbed when
they injured
themselves through
physical work
Growth and formation
(Sui/Tang Dynasty, Song/Jin
Dynasty)
The Peak (Ming/Qing Dynasty)
Advance developing (People’s
Republic of China)
1.2 History- The Peak Stage
(Ming and Qing Dynasty)
Dedications and Characteristics
1. Monographs of Infantile Tuina were published.
2. Eight Infantile Tuina manipulations were first introduced.
3. Comprehensive development of adult Tuina field.
4. Advocacy of apprenticeship learning methods.
5. First book describing the development of Tuina.
1.2 History- The Peak Stage
(Ming and Qing Dynasty)
1. 《保婴神术》Bao Ying Shen Shu (Magic Ways to Protect
Infants)
•The earliest extant Tuina monographs
2. 《小儿推拿全书》Xiao Er Tui Na Quan Shu (A complete book
for Infantile Tuina)
•The earliest popular separate edition monograph of Tuina
3. 《小儿推拿广意》Xiao Er Tui Na Guang Yi (General
Introduction to Infantile Tuina)
•The most comprehensive Infantile Tuina monograph in Qing
Dynasty
1.2 History- The Peak Stage
(Ming and Qing Dynasty)
4. 《幼科铁镜》You Ke Tie Jing (Iron Mirror of Pediatrics)
5. 《幼科推拿秘书》You Ke Tui Na Mi Shu (Secret Book on
Infantile Tuina)
•Most detailed and coherent Infantile Tuina monograph
6. 《厘正按摩要术》Li Zheng An Mo Yao Shu (Key
Manipulations of Authentic Tuina)
•Introduced 8 infantile Tuina manipulations:
1. Press “按”
5. Push “推”
2. Stroke“摩”
6. Feel “运”
3. Pinch “掐”
7. Knead “搓”
4. Rub “揉”
8. Shake “摇”
1.2 History- The Peak Stage
(Ming and Qing Dynasty)
Flourishing and comprehensive development of Tuina：
•Bone-setting Tuina
“正骨推拿”
•Acupoint Tuina
“点穴推拿”
•One-Finger Tuina
“一指禅推拿”
•Ophthalmology Tuina
“眼科推拿”
•Internal Medicine Tuina
“内科推拿”
•Healthcare Tuina
“保健推拿”
1.2 History- The Peak Stage
(Republic of China)
This stage provides a nexus of teaching for Tuina
Development. Different sects and schools of Tuina
appeared:
•One-Finger Tuina
•Acupoint Tuina
•Rolling Tuina
•Stomachache Tuina
黄汉如.《黄氏医话》Huang Shi Yi Hua (Huang’s
Medical Stories)
•First book concerning the development of
Tuina, published in 1933.
1.2 History Development
Germination Phase (Shang
Dynasty, Qin, Han Dynasty)
A form of technique
originated from
primitive people,
which they pressed
or rubbed when
they injured
themselves through
physical work
Growth and formation
(Sui/Tang Dynasty, Song/Jin
Dynasty)
The Peak (Ming/Qing Dynasty)
Advance developing
(People’s Republic of China)
1.2 History- Advance Developing
(People’s Republic of China)
Dedications and Characteristics
1. Comprehensive development period:
i.
Excavations and recompile of Tuina monographs.
ii. Introducing Scientific studies for Tuina
iii. System of education in Tuina has been completed.
iv. Scientific studies of Tuina have developed significantly.
v. Remarkable innovations have been made in Tuina.
1.2 History- Advance Developing
(People’s Republic of China)
Excavations and recompile of Tuina monographs
•Classic monographs were collected and published
•Summarize the scientifically and logically from the
theory of these Tuina monographs
•Apply western medicine diagnose and anatomic into
the practice of Tuina
1.2 History- Advance Developing
(People’s Republic of China)
Introducing Scientific studies for Tuina
•The theory of syndrome differentiation and treatment are
practiced in Tuina.
•Clinical research and scientific methods are performed in
Tuina therapy for treating diseases.
1.2 History- Advance Developing
(People’s Republic of China)
System of education in Tuina has been completed
•Training classes for Tuina were started in Shanghai Medical
School since 1956
•Specialty set up in colleges and universities of TCM in
China
•Tuina doctors with master/ doctor degree graduated from
universities of TCM
•Essentials of Tuina, Therapeutics of Tuina, Manipulation of
Tuina, Exercise for Infantile Tuina – teaching materials
1.2 History- Advance Developing
(People’s Republic of China)
Scientific studies of Tuina have developed significantly
•Researchers have studied this specialty with modern
science and technology in 1950s
•Data and proof shows that:
i.
ii.
iii.
iv.
Tuina can relieve pain according to neurophysiology.
Tuina can subdue swelling and revolve stasis.
Lower blood pressure and increase 5-HT.
Pinching spine promote absorbing functions of small
intestine.
1.2 History- Advance Developing
(People’s Republic of China)
Remarkable innovations have been made in Tuina.
•Ear Acupoint Tuina
•Foot Acupoint Tuina
•Sports Tuina
•Tuina anesthesia
Ear Acupoint
Foot Acupoint
1.3 Requirements for Learning Tuina
 Familiar with essentials, diagnostics, therapeutic methods
for both TCM and WM:
i. TCM: Theory of Yin and Yang; five elements;
nutrients/defensive Qi, Qi and blood; etiology;
pathogenesis; ;meridians;four diagnostic; eight
principles; syndrome differentiation treatment.
ii. WM: Anatomy; physiology; physical diagnostic;
motor physiology, nerve sections.
 Train up for special physical exercise:
i. Practice arduously according to the theory, methods,
exercise
I. Knowing the mechanism of Tuina.
II. Learn how Tuina therapy can activate blood and
resolve blood stasis
Regulating Yin and Yang
Improving deficiency and
reducing excess
Activating blood and resolving
stasis
Relaxing sinews and dredging
collaterals
Regulating sinews for repair
CHAPTER 2.1 Regulating Yin and Yang
Ying“阴”
Physiology
Yang “阳”
Balance of Yin and Yang
Tuina
Meridians
(Qi and Blood)
•Disharmony of Qi and
Blood
Pathology
•Imbalance of nutrientQi/defensive-Qi
Disorder of Yin and Yang
CHAPTER 2.1 Regulating Yin and Yang
The twelve meridians control human life, yet they
are the place where diseases can live. If disease
starts in the meridians, the physician can use the
meridians to treat the root cause of disease.
——Nei Jing
CHAPTER 2.1 Regulating Yin and Yang
Meridians
经络
Meridian channel
经脉
Associated vessels
络脉
It serves as the pathway for the transportation of qi and blood
throughout the body, thus connecting the viscera with extremities, the
interior with the exterior as well as the upper with the lower.
Meridians integrate the human body into an organic whole.
CHAPTER 2.1 Regulating Yin and Yang
Disorder of Yin and Yang
Balance of Yin and Yang
Promoting the flow of Qi and blood
Dredging the meridians and collaterals
Reinforcing the tendons and bones
CHAPTER 2.1 Regulating Yin and Yang
Example:
Hyper-activity
Inhibit
Invigorate
Hypo-activity
CHAPTER 2.2 Improving deficiency
and reducing excess
Lack of sufficient substances or hypofunction of
an organ
Excessive pathogenic factors or hyperfunction of
an organ
CHAPTER 2.2 Improving deficiency
and reducing excess
Stimulation
Frequency
Direction
CHAPTER 2.2 Improving deficiency
and reducing excess (Stimulation)
How does Tuina helps?
Adjust such morbid state to improve deficiency and reduce excess by means
of normalizing the flow of Qi and blood.
Excites
Mild stimulation
Tuina manipulations
Physiological functions
Strong stimulation
Inhibits
Stimulation
CHAPTER 2.2 Improving deficiency
and reducing excess (Stimulation)
Example: Indigestion
Spleen and stomach
deficiency
Gastric and intestinal
spasm
Soft kneading
Mild stimulation
Pishu, Weishu,
Zhongwan, Qihai
Strong knocking
Related Acupoints at the
back
Strong stimulation
Stimulation
CHAPTER 2.2 Improving deficiency
and reducing excess (Stimulation)
Example: Hypertension
Hyperactivity of liver
Yang
Retention of phlegm
and dampness
Pushing, pressing,
kneading
Qiaogong Region
Strong stimulation
Soft kneading
Pishu, Shenshu
Mild stimulation
Stimulation
CHAPTER 2.2 Improving deficiency
and reducing excess (Stimulation)
Mild stimulation
Longer time
Strong stimulation
Shorter time
Stimulation
CHAPTER 2.2 Improving deficiency
and reducing excess (Frequency)
The change of manipulations within a
certain range
The change of manipulations exceeding
a certain range
Quantitative
Qualitative
Frequency
CHAPTER 2.2 Improving deficiency
and reducing excess (Frequency)
Example:
Normal frequency
High frequency
Dredge the meridians and adjust
nutrient-Qi/defensive-Qi
Activate blood to subdue swelling
and drain pus to reduce toxin
Frequency
CHAPTER 2.2 Improving deficiency
and reducing excess (Frequency)
High frequency
Concentrated energy
Deeper region
Reducing
Low frequency
Diffused energy
Surface region
Reinforcing
Frequency
CHAPTER 2.2 Improving deficiency
and reducing excess (Direction)
Example:
Clockwise motion
Reducing
Anti-clockwise motion
Reinforcing
Direction
CHAPTER 2.3 Activating blood and
removing stasis
Promoting blood flow
Improving blood rheology
Reducing resisitance of blood flow
Improving functions of heart
Promoting the establishment of
microcirculation
CHAPTER 2.3 Activating blood and
removing stasis
Standardize pressure
Normal blood circulation
Fails to maintain
Standardize pressure
Blood stasis
Promoting blood flow
CHAPTER 2.3 Activating blood and
removing stasis
Manipulation force
Pressure of heart
Plasticity of wall of vessels
Increase local pressure
Immediate relief of sudden pressure
Invigorate blood flow
Propel the blood in microcirculation
Activate blood to resolve stasis
Promoting blood flow
CHAPTER 2.3 Activating blood and
removing stasis
Relationship: Rheology vs Viscosity
Quick blood circulation
Low blood viscosity
Slow blood circulation
High blood viscosity
Blood coagulate
Improving blood rheology
CHAPTER 2.3 Activating blood and
removing stasis
How does Tuina helps?
RBC
•Reinforcing
number of red
blood cells
Lymph
WBC
•Elevate the
ratio of lymph
cells
•Strengthen
the phagocytic
function of
WBC
Improving blood rheology
CHAPTER 2.3 Activating blood and
removing stasis
Relationship: Resistance vs Diameter
Resistance of blood flow
Diameter of vessels
Resistance of blood flow
Diameter of vessels
PS: Tuina can relax the vascular smooth muscles and dilate diameter of blood vessels.
Reducing resistance of blood flow
CHAPTER 2.3 Activating blood and
removing stasis
Sympathetic nerve
Adrenalin
Noradrenalin
lipoid
Ameliorate lymph circulations
Reduce resistance of blood flow
Reducing resistance of blood flow
CHAPTER 2.3 Activating blood and
removing stasis
Rhythmic beating of heart provides smooth blood circulation
Slowed heart
rate
Extended
diastolic
phase
Increased
infusion of
blood
Elevated
oxygen
supply
Reinforced
contraction of
left ventricle
Improving function of heart
CHAPTER 2.3 Activating blood and
removing stasis
Vascular net: a major place where blood and tissues exchange substances.
Norm: 8-16% blood capillaries are open.
Tuina therapy
32% blood
capillaries
opened
New vascular
net formed
Promote
repairing of
wounds/injuries
Promoting the establishment of microcirculation
CHAPTER 2.4 Relaxing sinews and
dredging collaterals
Pathological
Impaired tissue
Tuina
Tension and
spasm of
muscles
Reduction of
blood supply
Accumulation of
metabolic
substances
Adhesion, fibrosis,
scarring of
connective tissue
Chronic ischemia
and hypoxia
Inflammatory
pain and
hyperplasia
Promote the repair of the affected tissue
CHAPTER 2.4 Relaxing sinews and
dredging collaterals
stimulation
Muscle spindle receptor
Reinforce the contraction of muscles
stimulation
Tendon spindle receptor
Inhibit the contraction of muscles
Motor physiological
•Sufficient extension of affected muscles can excite the tendon spindle receptor
Manipulations for activating joints
Neurology
CHAPTER 2.4 Relaxing sinews and
dredging collaterals
《黄帝内经 》：“按之热气至”
“pressing will cause heat energy to rise”
Tuina
manipulations
Temperature
elevated
Relieve muscular
tension and
spasm
Heat energy
CHAPTER 2.4 Relaxing sinews and
dredging collaterals
Tranquilize the mind
Tuina therapy
Stop pain
Relieve muscular tension and
spasm
Relaxing sinews and
dredging collaterals
Increasing pain threshold
Reducing stimulation
Analgesic
CHAPTER 2.5 Regulating sinews for
repair
Dislocation of joints
Dislocation of shoulder joint
Pulling shoulder in sitting position
Semi-dislocation of articulatio sacroiliaca
Oblique pulling, stretching and bending the knee
Protrusion of lumbar vertebral disc
Oblique pulling and stretching the lower limbs
Dislocation of joints
CHAPTER 2.5 Regulating sinews for
repair
Streak-like eminence
Severe dysfunction of joints
Flicking, pushing and pulling
manipulation
Highlight: Manipulations of broken muscles, sinews & ligaments can only be resorted after operation suture
Transposition of soft tissues
Importance of mechanism of Tuina
• Using the law of syndrome differentiation of treatment to apply
Tuina manipulation
• Choose the suitable Tuina manipulation for different diseases
• The patient should feel an immediate positive effect after Tuina
• Acting as an immediate remedy with the absence of medicine
or acupuncture
• A healthcare method can be practiced wisely and correctly by
individual