Tuina manipulations should be persistent, forceful,even and gentle: Persistence means that manipulations should be continued for a considerable period of time.
Tuina manipulations are the direct means of tuina therapy. There are many kinds of operating skills and various forms of movements in tuina, which include butting with the head, tramping under the foot as well as continuous manipulations conducted with the finger, palm, wrist and elbow. They are directly applied to the body surface and stimulate the body by means of exerting force to treat and prevent diseases. Since most of the manipulations are done with hands, so they are generally called manual manipulations or hand manipulations.
Forcefulness means that manipulations should be performed with adequate force. Evenness means that manipulations should be rhythmical with appropriate speed and steady force. Gentleness refers to light but not superficial, heavy but not unsmooth operations with natural and smooth shift of movements, which should by no means be performed roughly and violently. The above four pointsare organically related to one another. To skillfully command various manipulations it is necessary to carry out long and persistent exercise and practice. In practice, theexercises should be done orderly and step by step, following a process from being inexperienced to skillful, to perfect and to able to apply with proficiency. One should try to attain the realm of "once in clinic, manipulations applied outside with wonderful result produced inside, manual techniques closely following the train of thought and good remedies coming from excellent manipulations."
In order to exert better curative action in practical application, tuina manipulations should carry out TCM principles of differentiating syndrome to decide treatment, which refers to applying different hand manipulations to different syndromes. People may be divided into the old and the young, constitution into weak and strong, syndrome into asthenia and sthenia, size of the operated parts into large and small and muscles into thick and thin. So selection of manipulations and application of force should be adapted to the above different conditions. Any excess or deficiency in manipulation will affect preventive and curative results or even cause some side effects.