The operational methods of massage practice

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Manipulation  Of   Approaches  Practice

In order to command techniques of tuina manipulations skillfully and obtain persistent strength, it is necessary to conduct hard, attentive and serious exercises.Some manipulations, especially those with complicated and more difficult skills such as rolling must be practiced repeatedly for a long period.
    
Practice of manipulation chiefly refers to training in skills of manipulation and strength of the finger, wrist and arm. It is generally divided into two stages: the first,basic training on the sand sack, and the second, operating practice on the human body after sand sack practice has laid some foundation. While conducting exercises of manipulation, no matter what they are, on a sand sack or on the human body, the student should have his mind concentrated on and be devoted to them wholeheartedly. Especially when doing practice on the human body, one should fathom the implications of gentleness, evenness, persistence and forcefulness of manipulations again and again. Only by painstaking training can one attain the objective of having everything under one's perfect control and gain a better effectiveness.

Practice on Sand Sack
    
Prepare a sack 26 cm long and 16 cm wide, fill it with sand or rice (it will be better to mix some broken sponge in to make the sack more elastic. ), and then stitch the sack mouth. Coat the sack with a clean cloth bag which is washed easily. At the beginning of practice, the sack may be tied tight and later loosened gradually. According to difficult degrees and essential points of movement of manipulations, one should have more practice on pushing manipulation with one-finger, rolling, kneading,grasping,  pressing and rubbing manipulations first.

Through the practice, the technique of movement and nimbleness of the principal manipulations can be mastered and the strength of the finger and wrist can also be built up. Either sitting or standing postures may be taken in practice. Manipulations of pushing with one-finger, kneading, pressing, rubbing, and arc-pushing, etc. should be practiced in a sitting posture, while manipulations of rolling and grasping in a standing posture. In practicing rolling manipulation, both the right and left hands should be trained alternately, while for other manipulations, practice is mainly conducted with the right hand.

 Practice on the Human Body
    
Practice on the human body is in fact a transition to application of tuina manipulations. So it should be conducted on every part of the human body in combination with the general routine operations in clinical treatment and according to the indications of manipulations as much as possible. In practice, attention is paid not only to operation of a single manipulation, but also to coordination of several manipulations such as pressing and kneading, nipping and grasping. Meanwhile, one should experience and observe carefully morphologic change and structure of the human body, activities of joints, elasticity and tension of muscles, tendons and other soft tissues, and exert different force and range in massage. A brief introduction to commonly used manipulations on different human parts and operating procedures will be given as follows.

Operating Procedures of Tuina on the Head and Face
   
The patient is in a sitting or supine position, and the doctor takes a standing or sitting posture.
   
Pushing manipulation with one-finger
   
Operate to and fro twice or three times from Yintang (EX-HN 3) to Shenting (GV 24).
     
Operate to and fro on both the right and left sides twice or three times respectively from Cuanzhu (BL 1 to Yangbai (GB 14) to Taiyang (EX-HN 5) and to Touwei (ST 8).
    
Do "oo" type operation twice or three times from Jingming (BL 1) along the left orbit to the right orbit,from inside to outside and from top to bottom, combined with wiping the area around the orbit.
     
Operate to and fro on both the right and left sides twice or three times respectively from Jingming (BL1) to Yingxiang (LI 20) to Dicang (ST 4) to Xiaguan (ST 7) to Jiache (ST 6) and to Chengjiang (CV 24).
    
Operate to and fro twice or three times from Yintang (EX-HN 3) to Shenting (GV 24) and to Baihui (GV20) or push Baihui (GV 20).
    
Press and knead the acupoints on the head and face with the thumb or major thenar, each point for 1 -3 minutes.
    
Grasp the five meridians. Fix the patient's forehead with one hand. Grasp the governor vessel on the head, the foot-taiyang meridians and the foot-shaoyang eridians on both sides with the separated five fingers of the other hand 5- 10 times from the face to the back of the head and stop at Fengchi (GB 20).
   
Sweeping manipulation.  Fix one side of the patient's head with one hand, put the five fingers of the other hand on the other side of his head and perform the operation on both sides 3-5 times along the part above the ear.
    
Wipe the head and face. Wipe with the major thenar of both hands 3- 5 times from the forehead separately to Taiyang (EX-HN 5) to mastoidea, and then to Fengchi (GB 20) on both sides of the patient's head.

Operating Procedures of Tuina on the Nape and Back
   
The patient takes a sitting or prone position and the masseur stands behind or on one side of the patient.
   
Push with one-finger manipulation 3 - 5 times from the inferior part of the occipital bone through Fengfu (GV 16) to Dazhui (GV 14).
   
Stick the lateral hump of the thumb to Fengchi (GB 20) and operate in a gesture of double-flying butterflies (Hudie Shuangfeishi) for 3 - 5 minutes.
   
Straight push the acupoint Qiaogong 5 - 10 times with the thumb of one hand.
   
Operate rolling manipulation to and fro from the inferior part of the occipital bone through Fengfu (GV 16) to Dazhui (GV 14) in combination with the patient's passive movement.
    
Operate rolling manipulation on Jianjing (GB 21) from one side to the other side to and fro 5 - 10 times.
   
Rotate and pull the nape moderately.
    
and down 3 - 5 times with the dorsum of a fist.
   
Pull and vibrate the thoracic vertebrae and thorax 3 - 5 times.
   
Grasp the area around Jianjing (GB 1) on both sides 5 - 10 times.

Operating Procedures of Tuina on the Chest and Abdomen
   
The patient takes a supine posture and the massagist sits beside him or her.
   
Push the conception vessel from Danzhong (CV17) to Zhongwan (CV 12) to Qihai (CV 6) to Guanyuan(CV 4), or other acupeints to and fro 5 - 10 times with pushing manipulation with one finger.
    
Push and rub Zhongwan (CV 12) and Tianshu (ST 25) for 1 - 3 minutes respectively.
   
Rub the abdomen rotationally with the whole palm clockwise and counterclockwise, each for 3 - 5 minutes.
   
Rub transversely the area from the infraclavicular part gradually to Danzhong (CV 17), Rugen (ST 18) and Jiuwei (CV 15) with the whole palm with to-and-froubbing manipulation. Or push and rub with the palm side from Tiantu (CV 22) along the front middle line downward twice or three times.
   
Push separately the chest and hypochondrium areas with both hands until they become hot.
   
Vibrate the gastroabdominal regions with one palm or overlapped palmar bases for 1 - 3 minutes with vibrating manipulation, which is performed by putting the finger or palm on the body surface or point and doing even, rhythmic and up-and-down vibrating movement. Or Digitally-vibrate Zhongwan (CV 12), Qihai (CV 6) or other points with the middle finger each for 1 minute.
   
Palm-twist the hypochondriac region, which is done by pressing from both sides of the trunk and twisting back and forth with both palms up and down 5 - 10 times.

Operating Procedures of Tuina on the Shoulder and Arm
   
The patient takes a sitting or lying position and the massagist stands beside the diseased side.
   
Push the area round the shoulder joint with pushing manipulation with one finger for 3 - 5 minutes.
   
Push from Jianyu (LI 15) to Binao (LI 14) to Quchi (LI 11) to Shousanli (LI 10) to Hegu (LI 4) to and
fro 3 - 5 times with pushing manipulation with one finger.
   
Rolling manipulation
    
Roll the anterior border of the shoulder joint with rolling manipulation, combined with passive inward and outward rotation of the shoulder joint for 3 - 5 minutes.
    
Roll the lateral border of the shoulder joint with rolling manipulation, combined with raising and adduction of the shoulder joint for 3 - 5 minutes.
     
Roll the posterior border of the shoulder joint with rolling manipulation, combined with retroflexion and inward rotation of the shoulder joint for 3 - 5 minutes.
   
Rotate the shoulder joint by holding the elbow or in the great amplitude 5 - 10 times.
   
Palm-twist the shoulder joint for 1 - 3 minutes.
    
Palm-twist the upper limb up and down 5 - 10 times.
   
Finger-twist and pull-extend all the interphalangeal joints once respectively.
   
Shake the upper limb moderately.

Operating Procedures of Tuina on the Lumbus and Lower Limb
   
The patient takes a prone or supine position and the massagist stands beside him or her.
   
Operate rolling manipulation along the sacrospinal muscles on both sides of the back and the lumbus to lumbosacral areas to and fro 5 - 10 times.
   
Operate rolling manipulation on each leg from Huantiao (GB 30) to Weizhong (BL 40) to Chengshan (BL 57) and other acupoints to and fro 5 - 10 times.
   
Press and knead Jiaji acupoints to and fro 3 - 5 times.
    
Rub directly the spinal column and the sacrospinal muscles on both sides of the trunk until they become hot.
    
Operate rolling manipulation on each leg from Biguan (ST 31) to Futu (ST 32) to Zusanli (ST 36) to Juegu (GB39) to and fro twice or three times.
    
Operate rolling manipulation along the medial aspect from the thigh to the shank to and fro twice or three times.
   
Press and knead the knee joints 3 - 5 times.
   
Percuss the areas from the thigh to the shank to and fro 3 - 5 times.
   
Operate oblique pulling manipulation or fixed-location waist-twisting once on the lumbar region.





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