Chinese Remedial Massage (Tuina)

8/10/2019 Chinese Remedial Massage (Tuina)

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Chinese Remedial Massage (Tui Na) By Dr. Henry Liming Liang, BMed, MMed, PhD

Dr Henry Liming Liang explains how Chinese Remedial Massage, based upon the meridian systemin particular, has developed many practical techniques over a long period of clinical practice, andhas been used for management of soft tissue injuries, internal diseases, as well as for health care.

Chinese Remedial Massage (CRM) is a natural medical system used in China for treatment of variedillnesses over four thousand years. Through this long-term clinical practice, numerous CRMtechniques were created and developed. There are more than one hundred kinds of CRMmanipulations recorded in Chinese literature. As an important part of Traditional Chinese Medicine(TCM), clinical application of CRM is based on the TCM theories, such as the concept of Yin andYang, Qi (energy flow) and blood, etc. Similar to acupuncture, CRM works on the meridian system,

but using the fingers instead of the acupuncture needles. Compared to other massage therapies, CRMcan be used for management of varied diseases and illnesses, by combining comprehensive CRMtechniques in conjunction with the meridian system.

CRM techniquesOver a long period of clinical practice, Chinese CRM experts created and developed many effectivemanipulations. There are more than one hundred kinds of CRM manipulations recorded in theChinese literature. However, around twenty to thirty basic skills are commonly used in clinical

practice at present. 1 CRM techniques are required to act in the deep tissues of the affected area, andrhythmically perform different manipulations. Thus, the CRM practitioner needs to undertakemanual training and further clinical practice. Some CRM manipulations are presented as follows:

Pressing manipulation is referred to An Fa in Chinese. This technique uses the finger-tip (thumb ormiddle-finger), or palm, or tip of the elbow, to press vertically on the affected parts or at theacupoints of meridians. Acupressure therapy should be included in this CRM manipulation,

because it commonly works on the meridian system, like acupuncture, but applying fingers instead ofthe needles. Pressing is wildly used for management of soft tissues injuries such as lower back pain,arthritis, etc; and internal illnesses such as headache, abdominal pain, period pain, etc.

One of softer techniques is rubbing manipulation, which is also called Mo Fa in Chinese. Thetechnique of rubbing is to rub circularly with the palm surface, or the surface of closed fingers (withindex, middle and ring fingers), on the affected area. This manipulation is commonly applied forhealing muscular injuries, or relieving pain or discomfort in the abdomen. Clinical experienceindicates that rubbing in a clockwise motion on the abdomen may promote constipation, while incontraclockwise may relieve diarrhoea.

Pushing manipulation (Tui Fa in Chinese) employs the surface of palm or thumb or tip of elbow to

push forward along on the affected region or on the meridian pathways. This manipulation is usuallyworked on the meridian system to circulate the Qi and blood. The application of massage oil orherbal oil on the operating area is necessary. It is used for soft tissue injuries, lower back pain,asthma, emotional stress, etc.

A special technique of CRM is named grasping manipulation, and Na Fa in Chinese. Thistechnique is to repeatedly and rhythmically grasp up and release the muscles and tendons of theaffected region, using three fingers (index, middle fingers and thumb) or five fingers. This


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manipulation is good for relaxing and strengthening the muscles and tendons, and commonly usedfor soft tissue injuries, muscular atrophy, etc.

The above-mentioned CRM manipulations are the most commonly-used techniques. Therefore,CRM therapy is also known as An Mo or Tui Na.

Therapeutic mechanism of CRMThe most common application for the conditions with CRM is to manage the injuries of muscles andtendons. CRM can directly relax the tense muscles when injured. Some of the CRM techniques canalso adjust the slightly dislocated tissues such as slipped tendons or discs, subluxation, etc. Inaddition, CRM may remove the tissue adhesion of the chronic muscular injuries.

Many scientific studies have demonstrated that CRM can increase the amount of white blood cellsand its activity, in particular lymphocytes of the body; this therapy can also promote the local bloodand lymphatic circulations. Therefore, CRM is able to reduce the local swelling and pain, and benefitfor tissue hearing. Further studies have shown that CRM can elevate the volume of endogenousopioid substance in the patients with back pain that may block the pain like pain-killer. 2

CRM is not only used for hearing of soft tissue injuries, but also for regulating the functions of theinternal organs. TCM theory holds that the meridian system is the link between the body surface andthe internal organs. In the meridian system, there are Qi and blood circulating smoothly andconstantly. CRM works on the meridian system allowing the stimulation to be transferred to theorgan through the relevant meridian, and therefore regulate the function of the organ. For example,

pressing at acupoint PC6 (all of the acupoint locations are described at the end of this article) mayregulate abnormal heartbeat. Pressing and kneading at SP6 may regulate abnormal menstruation. 2

Nevertheless, the detailed mechanism of CRM therapy for the management of diseases and illnesseshas yet to be the subject of further studies.

CRM for soft tissue injuriesSoft tissue injuries (STI) are defined as the traumatic injuries of muscles, tendons and joints. CRMused for treatment of STI can achieve better therapeutic outcomes, and is usually combined withacupuncture. The general steps of CRM for commonly seen STI are presented with examples asfollows. 3

A stiff neck due to STI commonly appears in the morning upon waking up, and presents withsoreness and tenderness in the neck, and limited movement. General process of CRM for thiscondition is: first, rubbing gently on the affected area applying with massage oil or herbal oil;secondly, pressing and kneading at the tender spots, and some acupoints such as GB20, GB21 andSI3; thirdly, pushing the neck, upper back and shoulder of the affected side, and finally grasping theaffected parts.

Periarthritis of the shoulder, also called frozen shoulder manifests pain and tenderness of theaffected shoulder, and limited movement of the shoulder elevation. Basic steps of CRM for thisdisease are: rubbing and rolling on the affected shoulder; pressing and kneading at the tender spots,and some acupoints such as LI15, GB21, LI11 and LI14; grasping and pushing the affected parts;finally passive movement by gently rotating the shoulder in directions of adduction, posteriorextension, abduction and elevation. As periarthritis of the shoulder is a chronic injury, CRM for thiscondition needs to be maintained for a longer period of time, and is combined with exercise of theshoulders.


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Tennis elbow is a common condition of sport injury. The key skills of CRM for this injury are:rubbing with herbal oil on the affected area of the elbow; pressing and kneading on the tender spotsand LI11, LI10, LI4, etc; scrubbing and then gently grasping the affected parts. The sufferer of thiscondition can treat him/herself by following this CRM procedure.

Lower back pain is usually caused by lumbar muscular injury. CRM for this condition is basicallyundertaken by the following procedure: rubbing and rolling on the lower back, and pressing andkneading on BL23, BL25, BL40, etc; then pushing and grasping the lower back, and finallyscrubbing the lumbar and sacral regions.

CRM for internal diseasesSince meridians are the pathways linking the body surface to the internal organs, CRM working onthe meridian system may regulate the functions of the organs. Thus, CRM can be used for internaldiseases or illnesses. Examples of the basic procedure of CRM for internal diseases are taken asfollows. 4

Migraine is a difficult condition to be managed clinically. CRM, usually combined with acupunctureand Chinese herbal medicine, is one of the therapeutic options beyond a pain-killer. The main stepsof CRM are:

1. rubbing and rolling on the neck, upper back and shoulders2. pressing and kneading at GB20, GB21, SJ5 and LI43. pushing from GB20 to GB21 for 10 15 times4. gently pressing and kneading at Yintang, Taiyang and DU205. gently taping on the head.

Insomnia may be due to varied causes, but CRM therapy holds that insomnia is generally caused byimbalance of Yin and Yang. Therefore, CRM is to harmonize the Yin and Yang using followingsteps:

1. pressing and kneading at DU20, BL2 and GB202. pressing and kneading at PC6, HT7, ST36 and SP63. rubbing on RN12 and RN4 area4. scrubbing the soles until hot sensation is achieved and finally tapping on KI1.

Asthma is another difficult condition, which is usually under constant medication. CRM can be usedfor complementarily relieving its symptoms. The procedure of CRM for this condition is:

1. Patient is in a prone position, the practitioner performs pushing on the meridians of the backdownwards for ten to 15 times; and then pressing and kneading at Dingchuan, UL13, BL15and BL17

2. The patient is in a supine position, the practitioner does a pushing downwards motion alongthe sternum; and then pressing and kneading at LU1, RN17, LU5 and LU10.

Period pain is a common gynaecologic condition, which can be treated with CRM. The steps of themanagement are:

1. the patient is in prone position, practitioner performs rubbing on the lumbar and sacral region,and pressing and kneading at BL23 and some tender spots, then scrubbing and striking onlumbar and sacral region

2. the patient is in supine position, practitioner performs a gentle rubbing on the lower abdomen,and then pressing and kneading at RN6, RN4 and SP6.


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CRM for health careIt is a fact that CRM is more commonly used for relaxation and health care. In particular, CRM withself-help can be applied in ones routine health care. The general steps of CRM for different parts ofthe body are summarised as follows. 4 This program is suitable for either sufferers self-help or

practitioners performance.

Head: Pushing the forehead forwards both sides; (2) Pressing Taiyang and pushing the temples backwards; (3) Pressing and kneading at GB20; (4) Cupping the Vertex.

Chest: (1) Pressing and kneading at RN17; (2) Grasping the greater pectoral muscle; (3) Cuppingand scrubbing the chest.

Abdomen: (1) Pressing and kneading at RN12, ST25 and RN6; (2) Rubbing on the abdomen for 30times in each of clockwise and counterclockwise.

Neck: (1) Kneading and pushing from GB20 to the low neck; (2) Tapping at GB21; (3) Cupping onthe neck & shoulders.

Lower back: (1) Pressing and kneading at UL23 and Yaoyan; (2) Striking on the lumbar region; (3)Pushing downwards along the meridians on the lumbar region; (4) Scrubbing on lumbar and sacralregion horizontally.

Upper limbs: (1) Pressing and kneading at LI15, LI11, SJ5, PC6, LI4, etc; (2) Rubbing on the jointsof shoulders and elbows; (3) Scrubbing on the upper limbs along the meridians.

Lower limbs: (1) Pressing and kneading at ST34, SP10, ST36, BL57, SP6, etc; (2) Rubbing on the joints of the knees and ankles; (3) Grasping the ligaments of knee joints, gastrocnemius muscles &achilles tendons; (4) Cupping on the lower limbs; (5) Scrubbing the soles and tapping at KI1.

SummaryChinese remedial massage (CRM), as an important part of traditional Chinese medicine, has beenused for treatment of varied illnesses over four thousand years. Clinical application of CRM is basedon the TCM theories, in particular, works on the meridian system. Furthermore, many effective and

practical techniques for CRM have been developed through a long period of clinical practice.

Therefore, CRM is an evidence-based therapy that can be used for management of varied diseasesand illnesses, including not only soft tissue injuries, but also internal diseases or illnesses; inaddition, it is also suitable for health care.

In order to develop CRM therapy, scientific research on CRM regarding therapeutic mechanisms,efficacy and safety is essential. It is worthy noting that primary training on CRM for massage

practitioners is also warranted.

8. Location of the above mentioned acupoints 5 BL2: in the depression of the medial end of the eyebrow.BL13: below the spinous process of the 3rd thoracic vertebra, 1.5 thumbs breadth lateral to the

posterior midline.BL15: below the spinous process of the 5th thoracic vertebra, 1.5 thumbs breadth lateral to the

posterior midline.


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BL17: below the spinous process of the 7th thoracic vertebra, 1.5 thumbs breadth lateral to the posterior midline.

BL23: below the spinous process of the 2nd lumbar vertebra, 1.5 thumbs breadth lateral to the posterior midline.

BL25: below the spinous process of the 4th lumbar vertebra, 1.5 thumbs breadth lateral to the posterior midline.

BL40: at the midpoint of the popliteal crease.BL57: on the posterior midline of the leg, below the gastrocnemius muscle belly.Dingchuan: below the spinous process of the 7th cervical vertebra, 0.5 thumb breadth lateral to the

posterior midline.DU20: on the head, five thumbs breadth directly above the midpoint of the anterior hairline.GB20: in the depression inferior to the occipital bone.GB21: on the shoulder, at the midpoint of the line connecting the 7th cervical vertebra and the

acromion.HT7: on the wrist, at the ulnar end of the crease.KI1: on the sole, in the depression appearing on the anterior part.LU1: on the level with the 1st intercostal space, six thumbs breadth lateral to the anterior midline.LU5: in cubital crease, in the depression on the radial side of the tendon of the biceps brachii muscle.LU10: on the radial side of the midpoint of the 1st metacarpal bone, and at the junction of the red

and white skin.LI4: on the dorsum of the hand, between the 1st and the 2nd metacarpal bones, and on the radial side

of the midpoint of the 2nd metacarpal bone.LI10: on the radial side of the dorsal surface of the forearm, 2 thumbs breadth below the cubital

transverse crease.LI11: at the lateral end of the cubital crease with the elbow flexed.LI15: in the depression anterior and inferior to the acromion when the arm is abduced.PC6: two thumbs breadth above the transverse crease of the wrist, between the tendons of muscle of

palmaris longus and muscle of flexor radialis.RN4: three thumbs breadth below the centre of the umbilicus.RN6: 1.5 thumbs breadth below the centre of the umbilicus.RN12: four thumbs breadth above the centre of the umbilicus.RN17: at the midpoint of the line connecting both nipples, level with the 4th intercostal space.SI3: at the junction of the red and white skin along the ulnar border of the hand, at the ulnar end of

the distal palmar crease.SJ5: 2 thumbs breadth proximal to the dorsal crease of the wrist, between the radius and the ulnar.SP6: 3 thumbs breadth above the tip of the medial malleolus, on the posterior border of the medial

aspect of the tibiaSP10: with the knee flexed, on the medial side of the thigh, two thumbs breadth above the superior

medial corner of the patella.ST25: two thumbs breadth lateral to the centre of the umbilicus.ST34: with the knee flexed, on the anterior side of the thigh, two thumbs breadth above the superior

lateral corner of the patella.ST36: on the anterior lateral side of the leg, three thumbs breadth below the patella, one finger breadth from the anterior crest of the tibia.

Taiyang: in the depression one finger breadth posterior to the midpoint between the lateral end of theeyebrow and the outer canthus.

Yaoyan: below the spinous process of the 4th lumbar vertebra, 3.5 thumbs breadth lateral to the posterior midline.

Yintang: on the midpoint between the bilateral eyebrows.


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Dr. Henry Liming Liang studied Chinese medicine including Chinese remedial massage for eight years at Guangzhou University of Chinese Medicine in China, and was awarded Bachelors and Masters degrees of Chinese medicine. He undertook his PhD study from 1996 to 2003 at RMITUniversity of Australia. Dr. Liang has had extensive clinical experience both in hospital and in clinicsince 1982. He is the principal of Sydney Institute of Traditional Chinese Medicine, and hasdeveloped and introduced an accredited diploma course of Chinese remedial massage.

References1. Yu DF, Cao RF, Wu JB. Remedial Massage in Traditional Chinese Medicine. Beijing: The

Peoples Health Publishing House. 1989: 40-56.2. Chang XJ, Fu Q. The techniques of special massage . Beijing: Beijing Publishing House of

Science and Technology. 1993: 153-61.3. Li YM, Sheng ZX. Treatment of Soft Tissue Injury with Chinese Tuina Therapy . Beijing: China

Publishing House of Traditional Chinese Medicine and Pharmacology. 1993: 21-30.4. Yu DF. Science of Chinese Massage . Shanghai: Shanghai Publishing House of Science and

Technology. 1996: 133-161, 230-6.5. Liu GW. A Complement Work of Present Acupuncture and Moxibustion (Acupoints and

Meridians) . Beijing: Huaxia Publishing House. 1998: 106-491.

Chinese Remedial Massage (Tuina)

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