Class Notes 3

Class Notes 3
Zhan Zhuang (3 minutes)

Silk Reeling

Grasp Sparrow’s Tail: Peng-Lu-Ji-An (or Lead Tiger up Mountain, Lead Dragon down to Sea, Push the Yin-Yang Palm Out, Push the Doors Shut)

Testing Rooting: Pressure at Hip, Pressure at Shoulder

Extension Practice: Leaning against the Wall with Elbows, with Fists, with Palms, with Fingers, with Thumbs

Hints and Tips on Different Techniques
1) With Pushing (Tui) techniques, there is always the possibility of overextension. It is okay to bend at the waist slightly in order to perform pushing, but if you find yourself leaning far over, or even uprooting yourself (feet on tiptoe or leaving the ground entirely), then you need to change your position. Reposition yourself. If you are covering a large/long area (like the back), it is far better to work in segments than it is to overreach yourself.

2) Related to #1 is the issue of body contours. The body has natural slopes and valleys. Generally, it is easiest (most comfortable) to push UP a slope. On the other hand, pushing DOWN into a valley tends to be both less effective (you are sliding more than you are putting pressure into the patient’s body) and more prone to overextension. The answer to this is still the same as in #1. Reposition yourself. For example, the most common place for this sort of problem to occur is at the head of the prone patient, when you are pushing down the back. At mid-back, there is a down slope. Instead of trying to cross this down slope while standing at the head of the patient, try repositioning yourself further down, and to one side. Also, see #3.

3) When Pushing, think about using your other (nondominant) hand. One important role that the nondominant hand can play is as an anchor. It can (lightly) press the tissue while the other hand pushes and lengthens the tissue. This can be key in certain areas like the (down-sloping) mid-back region.

The nondominant hand can also act as a reinforcer, particularly if you are using one of the smaller tools (like the thumbs or the fingers). You can stack the nondominant hand atop your primary tool.

The nondominant hand can also act as a guide. This can be particularly important on “slippery” or “tight” areas, like the paraspinals, especially if you are using particularly penetrative tools like the elbow. You can use the “tiger’s mouth” (between the thumb and index finger) of one hand to serve as a “stencil” to guide the elbow.

4) The easiest surfaces to work on (and this is definitely open to debate!) are:

PALM: Full palm/heel. The thenar/hypothenar eminences are okay, but if you slant too much into either, you start to feel torque in your arms. The “balls” of the hand produce far too much tension to be particularly effective.

FIST: By far, the easiest surfaces to use are the ulnar surface (like you are stabbing someone) or the “top” (between the MCPs and PIPs) of the fist (perhaps even with a bias towards particular MCPs). The former (ulnar surface) seems better when you are Pushing, whie the latter seems better for Pressing (although it could be used for both). Using the palmar surface of the fist might seem okay (and similar to the palm), but it loses the surface area of the palm while adding tension at the wrist. The back of the fist and the radial (thumb-side) of the fist are far too awkward for normal uses (although the back of the fist can come into play as a percussive instrument on the patient in sitting position).

KNUCKLES: Think of two surfaces: the PIPs of the second and third knuckles combined, and the PIPS of the third, fourth, and fifth knuckles combined. There are many ways to arrange the knuckles, but by far the strongest involves twisting your arm slightly. For example, if you are using the second and third knuckles to PUSH, instead of arranging your hand palm down towards the point of contact, try turning your whole arm (from the shoulder down) as though you were turning a doorknob counterclockwise, thumb close to the body surface. If you were using the third, fourth, and fifth knuckles together, you would turn your arm the opposite direction.

The reason this orientation is stronger is this. If you were to push with your palm facing the patient’s body, then you have to FIGHT the natural tendency for the knuckles to fold under (as in a fist), as well as a similar tendency at the wrist. This leads to countertension, and tension is the enemy to effective technique and sensitivity.

It is possible to utilize individual knuckles, but you have to be careful that they are strong (reinforced) enough. Use your other hand as a guide if you need to! This can be particularly important on areas like the shin (tibialis anterior).

FINGERS: Avoid using the tips of the fingers, especially for a Pressing technique. There are ways you can use them, but they must be reinforced, and even reinforced, it is inadvisable to put your full weight upon them. I would definitely avoid putting sustained pressure on them (in other words, not really suitable for true Pressing).

Instead, consider using the pads of the fingers. Imagine your fingers are either like the branches of a tree root growing into the ground, or a blade sinking into butter. You can spread your fingers apart (for a more superficial Push), or put a few of them together (2nd and 3rd, for a narrow area), or even use all of them together as a knife blade to sink obliquely into different parts of the body (like the front of the shoulder blade, deep within the armpit).

Always keep your fingers slightly flexed. DON’T HYPEREXTEND YOUR FINGERS. Hyperextension is a sure way to damage your fingers.

Again, use your other hand effectively. You can stack both hands together to apply a “double finger blade.”

THUMBS: The thumbs are really easy to use. That’s their danger. If at all possible, try to get in the habit of using other tools before you rely upon your thumb.

The best surface on the thumb is halfway between the pad and the tip. Try to either align your thumb next to the hand to provide reinforcement, or use the other fingers (splayed out like a spider) to provide further support. Use your other hand to reinforce if need be. This can be accomplished in various ways: for example, you could use two thumbs adjacent to each other, or use the other hand as a sort of guide…

FOREARMS: This tool requires you to get closer to the body surface. Accomplish this by lowering yourself via your LEGS first, and then, if need be, by bending at the waist. The best surfaces to use are the ulnar edge and the dorsal surface. The ulnar edge is best for Pushing like a motor grader or a lathe; the dorsal surface/elbow can be used to travel like a train along a narrow set of train tracks. Obviously, this tool can only be used on large areas that have deep tissue. I would use this on the lower back, and the thighs (and sometimes, with certain patients, on the calves).

ELBOWS: By far this is the most dangerous tool to use. Reserve it for your most robust patients, and the deepest tissue. You have to get low, as for the forearms. Start with your elbow pretty wide open, and only gradually decrease the angle (make it acute). Feel your way in. DON’T STAB your way in!!!

When using your elbow with Pushing, it is important that you maintain control, and a clear pathway. Use the tiger’s mouth of the opposite hand to guide your elbow on its course!

Rating Techniques

Practice combining the techniques with the tools, as we did last week. Use each combination on different parts of the body, specifically, the upper back, the shoulders, the arms (no direct pressure on elbows!), the lower back, the hip/buttocks, the legs (no direct pressure on knees!).

We will attempt to “quantify” the combinations of Tui (Pushing) and An (Pressing) with the different tools by assigning numbers to them. As the GIVER, try to rate the ease of performing a technique with a given tool (1 is very easy, 5 is very difficult). Also think about what the best part of the body to use the technique-tool combo would be.

As the RECEIVER, try to rate the amount of pressure (1 is little pressure, 5 is too much pressure) and the level of specific penetration (1 is very shallow penetration, 5 is too deep) of a specific technique-tool combination.

Tool↓/Technique→ AN (Pushing) TUI (Pushing)
Palm
Fist
Knuckles
Fingers
Thumbs
Forearm
Elbow

We’ll compare our insights afterwards.

Being Soft and Loose and Vigorous

In the previous class, we discussed the techniques of pressing (An) and pushing (Tui) with tools other than the palms. For the most part, these techniques are NOT vigorous, because the use of pressure automatically makes them penetrative (to greater and lesser extents), and we do not want to be vigorous when we penetrate; we lose control, we may cause damage, etc.

In today's class, we will talk about techniques that are vigorous and loose and soft. These are Yang techniques, in the sense that they remain on the surface and are fast (I know, I know, "loose" and "soft" tend to be Yin words, but we're talking about what the effect is on the patient, not on the practitioner). These techniques are intended to soften up larger areas of the body than the penetrative Yin techniques. They can be used either BEFORE a penetrative Yin technique (to "prime" the area for deeper work) or AFTER (to "spread" the softening evenly).

When you are soft/loose/vigorous, while you should retain a sense of your body's structure, your joints do not need to be as aligned/stacked/open as in penetrative techniques. In fact, what distinguishes these soft/loose/vigorous techniques is the MOBILITY of the joints between your body and your patient's. As the joints do not need to stay fixed in any one position to deliver "force" into the patient, they are allowed (and, in fact, required) to keep moving.

Imagine that you are a tree in a fierce windstorm. Although your legs remain solidly rooted, your shoulders/elbows/wrists/hands must remain loose and mobile; if they aren't, then when the wind blows, the bough breaks. Even if your hands are loose, if ANY JOINT on the branch (your arms) retains tension, it will: 1) restrict the technique, and 2) invite injury.

Another thing with these vigorous techniques: Don't forget to breathe! I don't have a rule about the nature of your breathing, i.e. breathing fast or breathing slow. But if you forget to breathe, then your body WILL tense up and you won't be able to do these techniques well.

Now, as with everything, these techniques have degrees. Nothing is pure Yin or pure Yang. So some of these techniques, while "vigorous" or "moving," can be used in such a way that they are more or less penetrative. To the degree that a technique becomes penetrative, you may have to: 1) slow the technique down, and/or 2) "open" or stack some joints.

RUBBING (Other forms)
Rubbing can definitely be considered an exemplary form of soft/loose/vigorous technique. One form that we didn't cover is used primarily on limbs. I call this "unscrewing the pipe." It is also described as "foulage technique."

Imagine the arm is like a heavy lead pipe. You want to unscrew the pipe. So you put each hand on either side of the limb and "unscrew," moving each hand in a back-and-forth motion. Keep things light and fast.

Another similar form (also used on limbs) is called the "indian burn." There is a similar twisting motion with this form of rubbing, but here, hands are wrapped side by side on a segment of a limb and twisted in opposite directions. Again, keep things light and fast.

SWINGING
The most popular form of Swinging is called Yi Zhi Chan (or one finger meditation). You use your thumb, and "swing" from the tip to the pad, back and forth. Don't just "swing" your wrist, keep your whole arm loose.

ROLLING (GUN FA)
This technique can be thought of as a form of Swinging, but it feels "rounder." You "roll" from the hypothenar (pinky) side of the palm, to the dorsum of the third knuckle. Again, don't just use one joint, use your whole arm. And try to keep the motion "round." Ideally, it should feel as though someone were rolling a ball on your back.

This technique can be more penetrative, if you slow down and "press" with your knuckles.

Alternatively, you can do rolling in another way. This was recommended by Maria Mercati in her book on Chinese Massage. Imagine that your hands are like rolling pins. You can start out with your palms flat on the patient's body. Then, you roll over the tips of your fingers, over each successive knuckle, until your hands end up like fists. And you "unroll" again. This type of rolling has a more longitudinal feel to it.

KNEADING (sometimes described as Grinding)
Kneading is a very important group of techniques. These techniques are far more penetrative than the others, and are usually performed much slower and with more intention. To put it simply, kneading is simply Pressure plus a circular technique.

Kneading can actually be performed with any tool that applies pressure. It is most popularly performed with the pads of the thumbs or the thenar eminences.

It can be performed with the palm or fingers on the abdomen, where it is described as Grinding.

VIBRATING (ZHEN FA)
This technique is held more or less stationary. It actually isn't so much a soft/loose/vigorous technique as a technique that derives from internal tension. If you tense up your muscles, your body will vibrate subtly. If a part of your body is touching the patient, then that vibration will pass into the patient.

You can perform Vibration with your palms (relatively easy) or with your fingers (harder). You can also perform Vibration through a palm. Unlike most of the other techniques we've talked about today, it's probably best/easiest to do this by exhaling in a slow, controlled way.

Class Notes 2

Class Notes 2

Today, we will return to two techniques we introduced in the previous class: Tui (Pushing) and An (Pressing). But we will be using different tools with these techniques, thus transforming them from relatively superficial techniques to deeper and more penetrating techniques.

Before we go into this, we should return to issues of proper body mechanics, because these will be even more critical as we use certain tools (especially the fingers and thumbs).

BODY MECHANICS REVISITED
When you apply any sort of pressure to a patient's body:

1) Think of a way to open ALL (or as many) joints between you and the point of contact. When you "open a joint", don't open it too much (in other words, don't "lock" a joint) because it will tend to cause an obstruction in your body, and will lead to eventual injury. Instead, open each joint "just enough" to allow your weight/force to "flow through" into the patient's body.

Imagine that your arms are like tree roots, only these roots don't suck water up, they push water out (like a garden hose, only with more structure). You definitely don't want any "kinks" in your tree-root-arms, because then the water won't be able to flow out of you. "Kinks" can be caused by joints that are too closed (like a bent elbow) OR too open (like a locked elbow). You again want your arms to be open "just enough" to allow the water/force/weight to flow through.

Certain joints have a tendency to be "too open" and thus prone to injury: the thumbs, the fingers, and the wrist, for example. Some joints tend to be "too closed": the elbow sometimes, and also the shoulder. Try to experiment to find the optimum "flow" between your body and the point of contact. IT SHOULD FEEL RELAXED!!!

Hints: Try to keep your fingers slightly curled when using their tips. Fingers and thumbs in particularly are prone to injury due to hyper extension (too open). Also, always keep your elbows dropped. This is a key idea in Taijiquan, but it is effective here. If you ever raise your elbow, you will notice what a strain it puts on your shoulder. So keep them down!

WEIGHT SCALE DEMONSTRATION

2) Related to the idea of OPENING the joints is that of STACKING the joints. Imagine that you are building a tower out of a stack of building blocks. The tricky thing is that when you are using your thumbs/fingers, you are building this tower with a SMALL foundation. Nevertheless, if this tower is going to stand, each successive block (or joint) must be "centered" over the previous one.

Imagine if you were building a tower of blocks, and each successive block was stacked too far to the left. Eventually, the tower of blocks would have to fall to the left. Similarly, when we apply pressure, if we don't "stack" our joints in an even and consistent way, then the "bottom joints" will have to collapse (leading to ineffective techniques AND possible injury).

3) Reinforcement: If you are using small tools like your thumbs, then it is best to do some sort of reinforcement. You have two hands, so you might as well use them together to reinforce each other. For example, instead of applying pressure with only ONE THUMB, try putting two next to each other.

Other examples of reinforcement include the technique I demonstrated in the previous class, of bracing the elbow against the hip.

Still other examples include using one hand as a guide for an unsteady or wobbly tool (more on this later).

4) The issue of HEIGHT. Okay, this is probably the biggest issue most of us face when working on people. In the clinic, we are usually working on people ON TABLES. If we want to perform our techniques with any degree of success, we have to make sure our bodies and their bodies have the optimum height relationship. If the patient is too high, then your techniques will be much weaker. If the patient is too low, then you will likely strain your back from bending over him/her.

WHAT CAN YOU DO?

Here are some suggestions:
a) Lower/raise the table.
b) Use a chair to prop yourself up.
c) Get on the table.
d) Modify your posture/technique.

With regards to d: Let me give an example. Let's say I wanted to work on a patient's trapezius muscles. I could stand up straight and apply pressure down on GB 21 AT AN ANGLE. But what if I happen to be very tall relative to the patient? I can't mechanically apply as much direct pressure as I'd like without feeling some kind of pressure in my back.

So what can I do? I can KNEEL at the optimum height (maybe even using a stool if I'm uncomfortable kneeling). I can kneel so that my shoulders and the patient's GB 21 are at the same height. Then I can apply pressure more directly into the contact point.

Note: the astute may see that this seems to contradict the principle of keeping the hara close to the point of contact. But in reality, this is just maintaining that balance, but with more emphasis on opening the joints (this time, including the shoulder).

5) USE WEIGHT NOT FORCE whenever possible. AFTER you've opened up your joints, etc. THEN USE YOUR BODY WEIGHT to FLOW INTO THE PATIENT. Recall the image of the tree roots that POUR WATER. Once the roots are in place, THEN if you "lean" (tip the tree), the water/weight will naturally FLOW into the patient.

The order of this is, I think, essential. If you are not structurally prepared (i.e. open, stacked joints, etc.) then when you lean your weight, your arms/hands/fingers will be structurally unsound, and will tend to buckle or, in any case, suffer unnecessary stress.

ATTITUDE REVISITED
Last time I spoke about maintaining an attitude of exploration, not attack. Let's expand on this idea.

Oftentimes when we encounter hardness, our first instinct is to "strike it." Unfortunately, this is not a very healing way of doing things. Striking things tends to produce a single sharp penetrative "spike," with no endurance.

Think about cutting butter with your finger. What happens if you attempt to karate chop a stick of butter with your finger? More likely than not, you will get "butterfinger." (SORRY BAD JOKE). Seriously, you'll probably only end up with the butter stuck around your finger.

But what if instead, you applied slow and steady pressure on the butter? Gradually, the butter would open around your finger, until you were able to cut it in half. This is our ideal when we penetrate. We are not trying to "cut through" in one swift strike. We are instead trying to "sink in" through patience and "weight/wait."

You can also think of this in terms of Yin and Yang. Generally, if you really want to get into the Yin (or deep) part of the body, you need to sink in slowly. If, on the other hand, you only want to emphasize the Yang (or shallow) part of the body, you can use rapid, superficial techniques. Because of the way the body generally protects itself, if you use rapid, penetrative “attacks,” the body will tend to tense up and prevent you from going deep.

CORN STARCH EXPERIMENT

Okay, now let's practice some of our techniques.

PRESSING (AN)
Pressing is actually easier to practice, since it only involves putting weight into an object (there is no additional vector).

Last time, we used Palm Pressing.

Experiment with Pressing with other tools:

1) Different Parts of the PALM: the thenar eminence, the hypothenar eminence, the heel of the palm, the "knuckles"/head of the palm

2) Different Parts of the FIST: the palm side of the fist, the pinky side of the fist, the knuckle side of the fist, the back of the fist

3) The wrist (similar to the palm and the fist): the palmar side, the dorsal side

4) The PROXIMAL INTERPHALANGEAL JOINTS (the "second" knuckles of the fingers)

5) The fingers (THIS IS DIFFICULT!!!): first, try individual fingers, just to see how that feels; then, try different pairs or groups of fingers; then, try all fingers together or spread out; experiment with using different edges of the fingers (i.e., not just the finger tips, but also the pads and the lateral edges); FINALLY, try to figure out ways to REINFORCE the fingers (via other fingers of one hand, or with the other hand)

6) The thumb (AGAIN, DIFFICULT!!!): experiment with ways to use the thumb in such a way that it is not uncomfortable or hyperextended; think about how the other fingers act as support for the thumb; use different surfaces of the thumb; find ways to reinforce the thumb

7) The forearm: experiment with different sides of the forearm

8) The elbow (VERY VERY DANGEROUS!!!): please, at this point, experiment on a massage TABLE, not on a person. Until you feel comfortable and can exercise control with this tool, don't use it on a person. It really can cause significant injury if you're not careful. That being said, try: using different elbow surfaces, using different angles.

What are some other tools you can think of?

Okay, now let's move on to PUSHING (TUI).

This is a harder technique, because in addition to the pressure, you are adding a direction. This means several things:

First, make sure the patient is prepared. Usually, for the more penetrative forms of Tui, exposed skin is better. It's not that you can't do Tui on clothing, it's just that it tends to stretch or even tear things. As you might imagine, you can't just do Tui on exposed skin alone either. You need to use some kind of liniment, NOT TOO GREASY, or your technique will just slip around (it won't have any penetration).

Second, you need to make sure that you are able to Push a fair distance without feeling yourself get overextended. You may need to get closer to the table. You may need to prop yourself up over the patient. You may need to take a different stance.

Now, even though this technique has a directional element to it, don't forget: open/stack the joints first, then add weight (penetration), AND THEN (and only then) attempt to add a direction.

Please experiment with many of the same tools used for the Pressing exercise.

You may find some tools are more amenable to Pushing. For example, using the forearm seems great for Pushing, because it feels like you are a motor grader or a bulldozer.

PRACTICE
Work on the patient’s back, with the patient lying face down.

Start with some Rubbing (Mo Fa) with the Palm. Remember to find a good place to stand to practice your techniques.

Press (An Fa) the back with the Palm. There are different ways to do this. DO NOT PRESS DIRECTLY ON THE SPINE. Instead, press on the paraspinal muscles to either side of the spine.
Try to Press with both hands on either side of the spine. First, press with even pressure on both hands. Then, try to SLOWLY alternate pressure between one hand and the next (BE CAREFUL DOING THIS. Imagine you are Walking on eggshells, and too much pressure will cause things to crack). Start from the head of the table, and work your way down as far as is comfortable. When you feel yourself overreaching, switch to standing to one side of the table and work your way down.

*ALTERNATIVELY, only for those who are comfortable with this, you can go on the table, straddling the patient, and press the mid to lower back.

You may also START from one side of the table, and press on the contralateral (opposite) side of the spine, as though you are trying to push tissue away from the spine. You can “walk” your way down the spine.

Switch between the different tools: Palm, Fist, Wrist, Knuckles (PIPs), Fingers, Thumbs, Forearms, Elbows. Communicate with your patient to ask what each tool and technique feels like. Also, notice in yourself, what tools and techniques feel comfortable and effective.

Practice your Pushing (TUI) with different tools. This will require more Rooting, and more of a focus on your stance. It will also require a LIGHT amount of liniment. Work down the length of the back, and to keep things simple, just do one side at a time. Start with the Palm, then go on to the other tools: Fist, *Wrist, Knuckles, *Fingers, *Thumbs, Forearms. The tools with asterisks need to be done with caution. If you feel any discomfort, change something about how you’re doing the technique or discontinue it for now.

Practice with the Elbow only on the table surface for now. It is very dangerous...

Class Notes 1

CLASS NOTES 1
What is Tuina?

Tuina is often thought of as, simply, Chinese Massage. This is not entirely accurate, because there are other forms of Chinese Massage. Nevertheless, Tuina is perhaps the most well-known and general form of massage.

"Tui" means "Push" (not the push we usually think of, as in "push and shove"; we will talk about this later), and "Na" means "Grasp." These two techniques are considered important to this form of massage; however, Tuina encompasses several other kinds of techniques.

History of Tuina

* The earliest reference to any sort of bodywork in China occurs in the Huang Di Nei Jing Su Wen, when the Yellow Emperor asks his physician Qi Bo of the role of therapeutic massage and bodywork. Qi Bo says: "In the spring and summer, when food is plentiful and humans tend to become lazy and slothful, finger pressure is used to increase digestive fire and restore vigor."
* During the Qin Dynasty (3rd century BC), bodywork was known as Moshou (Hand Rubbing).
* During the Han Dynasty (206 BC - 220 AD), bodywork was known as Anmo (press and rub). It is believed that Chinese Anmo is the inspiration for many other Oriental forms of massage. During the 6th century, Anmo spread to Japan and Korea. In Japan, Anma (same characters) developed; nowadays, Japanese Anma is considered primarily a form of abdominal massage. It is believed that Shiatsu also developed from Chinese Anmo.
* By the 5th century AD, a doctoral degree was created specifically for Chinese Anmo at the Imperial College of Medicine in Xian (capital during the Tang Dynasty).
* It was only during the Ming Dynasty (1368-1644) that the term Tuina came to be used.
* TUI NA vs. AN MO. Although this is not a rough and ready rule, we may say (particularly if we look at Japanese Anma, a development of Chinese Anmo) that AN MO is a gentler form of massage, largely geared towards "rubbing" the superficial tissues; TUI NA incorporates AN MO, but seems geared more for treating musculoskeletal disorders with more aggressive techniques.

How is Tuina different from other types of bodywork?

First of all, it should be said that bodywork is a pretty universal practice, occurring in some form in all cultures. To say that one form of bodywork was spread from one place to another may be partially true, but to say that bodywork as a practice in its entirety did seems somewhat naive and arrogant.

Tuina differs from other forms of massage in that: 1) it can be performed with patients fully clothed (although it can perhaps be performed better with patients exposed); this differentiates it from, say, Swedish Massage; 2) while it can use oils and liniments, it also doesn't necessarily need those (again, this differentiates it from Swedish Massage); 3) its techniques are not limited to thumb and finger pressure, and while Shiatsu is not necessarily limited to this either, Tuina generally involves a greater variety of techniques than Shiatsu; 4) Tuina is USUALLY practiced on a table, whereas Shiatsu and Thai Massage are often practiced off the floor.

Bottom line: Tuina, like other forms of bodywork, differentiates itself in the body of techniques that are particular to it, and how those techniques are performed.

Proper Attitude

In general, it is best to adopt a gentle attitude when working on ANYONE (even "tough" patients). When you work on a patient, don't think about "working" him/her, like a piece of clay. Think instead that you are trying to explore and learn about the patient. Your hands, fingers, whatever are like the roots of a tree searching for water. If you think of your work as more a "growing out" and an "exploration," you are less likely to "stab" or "push" (and therefore hurt) your patients.

ALWAYS REMEMBER THIS... It is easy to forget, but it makes both YOUR and your patient's experience positive.

Contraindications

I reproduce this in its entirety, since it’s a substantial list. I don’t necessarily agree with all of these, by the way:

“Unknown diagnosis, overeating, excessive drinking, drunkenness, anger or rage, deep sorrow, being extremely tired or hungry.

“Infectious diseases such as leprosy, plague, hepatitis, open wounds or fractures, scalds, burns, various malignant tumors, disorders with tendency to hemorrhaging, tuberculosis, psychosis. Pregnant or menstruating women should be treated later or with great caution.

“Perfunctory manipulation, clumsy or harsh procedures, or making jokes are clinically inappropriate. (It is a good thing to use some levity to put a patient at ease, but a joking attitude undermines confidence and is not desirable.)”

Principles of Bodywork

You need to know the correct principles of bodywork in order to protect yourself from injury, and in order to make your techniques as effective as possible.

First of all, you need to relax your body as much as possible. Although it may seem like bodywork demands a lot of physical exertion, it really doesn't. Most of your "strength" or "power" comes from gravity and your body structure.

A good exercise to work on relaxation and grounding is Zhan Zhuang, or Pile Standing, from Tai Chi (and also other internal martial arts styles and Qi Gong). Simply stand with your feet roughly shoulder width apart, knees slightly bent. You may hold a variety of postures with your arms and hands. A common version says that you should position your arms as though you were holding a tree. Relax, keep your back relatively straight, and drop all tension down through your feet into the ground.

Now, we're not always going to keep our weight even on both feet. Sometimes we will be pushing weight forwards, other times we will be pulling weight back. So, we should be practicing other stances:

BOW STANCE
4-6 STANCE
CAT STANCE

The point is not to adopt these formal (and maybe inappropriate) stances while working on patients. The point is to BE AWARE of where you place your weight. FEEL your feet, FEEL where you place your emphasis as you stand. And try to match your weight with your technique.

A Complex and Simple Idea: Triangles

In physics, there is the theoretical idea of both the irresistible force and the immovable object (which would win?). Although we need to use some degree of force to achieve our aim of penetrating tissue, we do so not by emulating the "irresistible force," but by becoming the "immovable object." That is, we need to connect to the ground, which is the most "immovable object" in our immediate vicinity.

Whenever you apply pressure to an object, especially penetrative pressure, the object resists with a force of its own. If you are using your thumb to penetrate someone, for example, this force of resistance (or counter force) will put stress on your whole body through the thumb (ultimately, it will lodge itself at the weakest link, often, your thumb joint). If you are not well-connected to the ground and relaxed, then that counter force will either throw you off balance, or it will pass into a weak and tight part of your body, and perhaps injure you there.

We use our lower body to root ourselves. The best shape to emulate when rooting is a triangle, and in particular, the right triangle. One leg is always vertical, and it seems to carry most of the weight. The other leg, whether extended behind or before us, is the support leg. In the Bow Stance, for example, if the counter force is powerful, it can travel through the rear support leg, and back into the ground.

TO ACHIEVE PENETRATIVE FORCE, BALANCE TWO OPPOSING FACTORS: 1) Bringing the Hara (Dantien) close to the point of contact, and 2) Extending or opening the joints between the point of contact and the Hara.

This seems like a complicated statement, but it really isn't. To use force effortlessly, you need to balance two somewhat opposing tendencies. First of all, you need to bring your Hara as close as possible to the point of contact (wherever you are applying pressure). You can do this by leaning in, or even by turning your waist slightly. Of course, you can't just collapse the distance between your center and the point of contact; that wouldn't accomplish anything at all. You have to balance this with the second point: opening all the joints between the point of contact and the Hara. So, for example, if you are using your thumb to apply pressure, you can increase the force by opening your wrist joint (aligning or stacking it), and opening your elbow joint (this doesn't mean LOCKING the joint!). We DON'T open the shoulder joint, because this would INCREASE the distance between the Hara and the point of contact (and thus break the balance).

The other way to increase force without increasing effort is to use spiraling force. Imagine your whole body, your arms, legs, and torso, as being like a screw. A screw has penetrative power because it twists. You can increase your force simply by "turning screws" slightly, whether that means turning your legs, turning your waist, or turning your arms. This is all "heady stuff," but hopefully we can get it eventually.

HANDS ON WALL EXERCISE
SPIRAL TWINING OR SILK REELING EXERCISE

Another way to think about this is articulated by Ohashi, a Shiatsu teacher. According to Ohashi, each part of our body is linked to its exact contralateral opposite. So, for example, our left hand is connected to our right foot. What this means, in practice, is that the “strength” or “force” of any given part of our body is controlled/determined by the exact contralateral opposite part of our body. If you want to develop more “strength” in your left hand, then you sink/press down your right foot.

This is actually just another way of visualizing/conceptualizing the Triangle Idea or the Spiral Twining Idea from above. There are many ways to talk about this ideal feeling when working. The bottom line is, however you conceptualize it, that you remain as relaxed as possible while working on your patient, and use the least “stress/strain” with the most effective technique possible.

TAIJIQUAN: Peng-Lu-Ji-An (Grasp Sparrow’s Tail)

Slow Penetrative Force

This follows from all previous statements. In bodywork, our aim is not to develop powerful "strikes" as though our patient were some kind of punching bag. Rather, we are trying to sink into the tissues of the patient, the same way that a knife can cut through butter, given enough time. So our aim is to deliver slow but constant pressure.

Reinforcement

The weak links in our body are our joints. To protect these weak links, sometimes we reinforce our joints. For example, if we use the thumb joint of one hand, we can use the other to gently support that thumb joint. Or, we can use two thumbs next to each other. That way, the counter force is distributed over TWO joints, and not just one.

Your Tools

You can use different parts of your body. Note that the part of the body used VASTLY changes the nature of the technique employed. The more "pointy" parts of the body (... don't go there...) can be considered to be Yin in the sense that they tend to be more penetrative. The flatter parts of the body, meanwhile, can be considered Yang, in the sense that they stay on the surface. So the same technique changes drastically depending upon whether you use a Yin or a Yang tool. Here are the tools:

Palms (different parts)
Thumbs
Fingers
Knuckles
Fists
Forearm
Elbow
Knees
Feet

Yin and Yang in Bodywork

When thinking about bodywork, it is best to consider its Yin and Yang. What are the qualities of Yin and Yang that are relevant here?

Yin is deep, slow and sedating. Yang is shallow, fast and tonifying/invigorating.

As you perform bodywork, you need to think about the Yin/Yang of your techniques and your patients. Some techniques are best for certain kinds of patients; for example, Yin techniques might be better for "hypersensitive" patients, while Yang techniques might be better for patients with depressed, slow energy.

Mixing Yin and Yang qualities in single techniques can give them more "character" and specificity, but remember that it can also make them more dangerous. For example, it is inadvisable to perform a technique that is BOTH deep (Yin quality) and fast (Yang quality). Not many patients can tolerate it, and besides, you may lose control and do damage. A shallow (Yang) and slow (Yin) technique, on the other hand, may prove to be extremely calming for the right patient

EXERCISES FOR THE HANDS AND WRISTS
Open-Close Hands, Wrist Circles, Stretch Forearms
“Push ups” against Wall with Fingers, Thumbs
Pressing into Mattress with Fingers, Thumbs

TECHNIQUES:

RUBBING (MO FA)
Rubbing is a relatively superficial technique. It involves rubbing the skin lightly, and often rapidly. Its purpose is primarily to WARM the tissues.

Stick to the Surface!!!
Generally done with a circular motion.
Rate: 30-40 to 200 times a minute.

-with flat of thumbs:
example: on GB 20 (Fengchi)
example: on Back Shu line.

-with palm:
example: on large areas, like chest, abdomen, back

-with palm heel (the pads on either side of base of palm):
example: lower back region

PUSHING (TUI FA)
Pushing is the Tui from Tuina. It is basically pressure combined with a vector, or direction. In other words, you apply some pressure to the patient’s body AND you move or push that pressure in a line. You can go in one direction or back and forth with pushing.

-Depth: varies from superficial to deep, depending on tools and intent.
-Rate: 50-150 times a minute; generally start slow.
-Pushing can be done in a back-and-forth way, OR in one-directional strokes.

-with flat of thumbs, with side of thumbs, with tip of thumbs: on small areas, or on head (browline, Du line).

-with flat of palms: on limbs (distal to proximal).

-with base of palms: on back

PRESSING (AN FA)
Pressing is basically vertical pressure into the patient’s body.

-Depth: varies, but direction is always INTO the core of the patient’s body.
-Remember to be gradual in going in and out!!!
-Follow patient’s breath if you are working on the torso.

-with palm (single, two palm, two palm opposed): example: low back, abdomen, head.

-with thumb: example: Taiyang.

-with elbow: example: buttocks