CHINESE MASSAGE TUINA INTRODUCTION
Chinese Tuina was called massage or Mosuo in ancient times. The term Tuina was first seen in the Ming Dynasty (1368-1644 A. C.). Chinese Tuina is a therapeutic approach guided by the theory of traditional Chinese medicine (TCM) and used to treat diseases through massage manipulations or by means of some massage tools applied to certain parts or points on the human body surface. It belongs to the category of external treatment in TCM. Tuina is an important component of Chinese medicine. Which is very effective in curing and preventing diseases and has made great contributions to thriving and prosperity of the Chinese nation?
BRIEF ACCOUNT OF DEVELOPMENT OF
Tuina originated from labor. and labor was the first essentials for the survival of the human beings. In the prehistoric age the human beings hunted and opened up wastelands to fill their belly, broke branches and piled up stones to build their shelters. sewed leather and made clothes to keep themselves warm and trudged very far to look for living stuff. While doing so, injuries such as fractures, contusions and strains happened to them constantly. In this case man would instinctively press with hands to stop bleeding and rub to eliminate swelling and pains. After long-term accumulation, the ancient people gradually understood and summed up some primitive TuiNa methods， which later became one of the commonly used techniques in treating diseases.
ANCIENT CHINESE MASSAGE-ANMO
The period from the Xia dynasties (21st-16th B. C.), Shang dynasties (16th -11th B. C.) and Zhou dynasties (11th-221 B. C.) to the time when Qin Shihuang (the first emperor of the Qin Dynasty) (221-226 B. C.) united China is called the prior-Qin period in Chinese history. It was recorded in the literatures that in this period there had been a lot of medicinal books circulating among the people. Unfortunately all the books were lost later in wars. Of the great many treatises on medicine compiled by hundreds of scholars, only very a few had been kept down. Therefore the knowledge of the achievements in tuina of this period is mainly from the two important archaeological discoveries: the unearthed oracle inscriptions on bones or tortoise shells of the Yin-Shang Dynasty (16th-11th B. C.) and the records of the medical books from the tombs of the Han Dynasty (206 B. C.-220 A. C.) in tom: Mawangdui at Changsha city. The people of the Yin-Shang Dynasty (16th-11th B. C.) were superstitious and they chiefly used prayer and sacrifice to eliminate illnesses and misfortunes when they were ill. So although there were a lot of records about diseases in the oracle inscriptions on bones or tortoise shells, only very few on treatment with medicines could be seen. Yet in these inscriptions there were many words about tuina therapy, which showed that besides sacrifice, the people of the Yin-Shang Dynasty (16th-11th B. C.) mainly used tuina to treat diseases.
Tuina was their creation and they were very skillful in applying It. Among the medical books, written on silk unearthed in tomb: Mawangdui and named Fifty Two Medical Prescriptions, mostly involved treatment of diseases with tuina. Tuina therapy in this book had two striking characteristics. One was the record about medicated tuina and ointment tuina, which were the earliest methods in the development of tuina in spite of being simple in making. The other was the record of plenty of tuina tools with distinguished features. For example， the taper wood tool used for treating hernia, the copper coin for infantile convulsion and the most characteristic medicated towel.
The former was the first monograph on massage in Chinese Tuina history, and the latter was the earliest great TCM works in existence. In classification， “Ten Volumes on Tuina of Huangdi Qibo” must have mainly concentrated on tuina, and by medical origin it was surely one branch of the same source with “Huangdi Neijing (Yellow Emperor Inner Scripture)”, which was the other branch. “Huαngdi Neijing (Yellow Emperor Inner Scripture)” mainly recorded the theories of TCM and acupuncture, while “Ten Volumes on Tuina of Huangdi Qibo” was chiefly about tuina and health care. It was a pity that the great works of ten volumes on Tuina was unable to survive on wars so that nowadays we could not have an all-round understanding of the development of tuina in the time before the Western Han Dynasty (206 B. C.-24 A. C.). Little to our relief，there were some literatures on tuina in “Huangdi's Canon of medicine”. It could be seen through a comprehensive view of Neijing (Yellow Emperor Inner Scripture) that the unique therapeutic system of tuina had been formed in the Qin and Han (221 B. C.-220 A. C.) period. Many paragraphs in the book were the theoretical summarization of tuina treatment from the Yin-Shang Dynasty (16th-11th B. C.). It was pointed out in Neijing that Chinese Tuina originated from and formed in the central region, equivalent to today’s Luoyang area of Henan Province, which was the border of the Yin-Shang (16th-11th B. C.) people at that time. That tallied with the contents of tuina described in the oracle inscriptions on bones or tortoise shells of the Yin-Shang Dynasty (16th-11th B. C.). Inspection : listening and smelling; interrogation and palpation diagnoses are the most important diagnostic methods of tuina. In Neijing (Yellow Emperor Inner Scripture) there were many parts about the application of tuina manipulations to palpation diagnosis，which improved the accuracy of diagnosing diseases.
Neijing (Yellow Emperor Inner Scripture) fully affirmed the therapeutic effect of tuina and held that tuina had the function of promoting qi to activate blood. eliminating cold to stop pain, dredging the meridians and reducing fever to tranquilize the mind. The book also pointed out that attention should be paid to reinforcement and reduction of tuina and its coordination with acumox, meditation and other therapeutic methods. In addition, there were a great many records about tuina manipulations in Neijing (Yellow Emperor Inner Scripture). Pressing, rubbing, cutting, palpating, feeling, clapping, flicking, grasping, pushing, weighing down, flexing， stretching， rocking，and so on，among which pressing an drubbing manipulations were most commonly used. That was why tuina was also called Anmo (pressing and rubbing) at that time. It was mentioned in Neijing that round needle and Di needle of the nine kinds of acupuncture needles might also be used as tuina tools, and the round one was used for reduction and the Di needle for reinforcement. Discussion and summary about tuina were certainly much more than the above in Neijing (Yellow Emperor Inner Scripture).
Neijing (Yellow Emperor Inner Scripture) established the basic theory of TCM. its main theories were also the most important guiding principles of tuina， which included the theories of zang-fu (internal organs)， meridians， yin-yang， five elements，Qi， blood and body fluids and diagnostic methods and therapeutic principles as well. The prominent doctor of the Han Dynasty (206 B. C.-220 A. C.)，Doctor Zhang Zhong jing，listed the ointment tuina as one of the methods of health care for the first time in his book: “Synopsis of Golden Chamber”. He also introduced a massage powder for treating headache due to wind with tuina, the prescription only contained Radix Aconiti Praeparata and salt. Modinggao (an ointment for massage on the head) and its similar kinds that appeared in later time，all derived from it. In the same book Dotor Zhang also carefully recorded a tuina technique for saving persons who hanged themselves, which was generally acknowledged as the earliest scientific method recorded for rescuing the hanged by the medical world and a proud achievement in the history of tuina. Another famous doctor， such as Doctor Hua Tuo promoted the frolics of five animals, which led daoyin (physical and breathing exercises) and tuina close to bionics， and provided a set of effective means of health care for the later generations. He was good at applying ointment massage and the first person to employ the ointment massage extensively in clinic. In a word，from instinctive pressing and rubbing behavior，through long time of accumulation，. up to the summaries made in Huangdi Qibo Anmo (Yellow Emperor Chi-Bo Massage) and Huangdi Neijing (Yellow Emperor Inner Scripture), tuina finally developed into a clinical subject with its own unique therapeutic system. It was not only summarized and improved theoretically, but also became clinically mature and extensive with its own unique feature through the introduction and application of that time's famous doctors Bian Que， Zhang Zhong jing. Hua Tuo. etc.
Therefore the Qin and Han Dynasties (221 B. C.-220 A. C.) were both the period of formation of the specific therapeutic system and the flourishing age of tuina， which linked the past and future in its history of development.
In the Jin and Tang Dynasties (265 – 420 A. C.) the rulers gradually valued tuina therapy. In the Office of Imperial Health of the Sui Dynasty (581- 618 A. C.) the title of massage doctor was authorized for the first time. On the basis
of the Sui's office，Tang’s Emperor set up an Imperial Health Administration with larger scale and better facilities, in which there was a tuina department. Three academic titles were given to masseurs, i. e. massage academicians, massagists arid massage workers. Assisted by the massagists and massage workers， the academicians taught the massage apprentices Daoyin (Guiding) methods (a self-tuina exercise) to take away diseases and rectify injuries. Tunia teaching came to be organized. Self-tuina was also laid stress on in this period. Many records about methods of self-tuina such
as tuina method of ancient India and Laozi (the leader of Taoism) Tuina could be found in “Handbook of prescriptions for Emergencies” and “Valuable Prescriptions” . In each chapter of “General Treatise on the Causes and Symptoms of Diseases”, included daoyin (Guiding) method for health preservation. He especially valued the technique of abdominal tuina for that purpose. The extensive use of self-tuina indicated that massotherapy began to be used for health care and prevention of diseases and for exertion of patients’ subjective initiative in fighting against diseases. The complementing effect of medication and tuina manipulations greatly promoted the development of massotherapy. There was a Doctor Ge Hong. He took application of ointment tuina seriously and was the first specialist to expound it systematically and make it perfect in syndrome, therapeutic principle, prescription and medication.
RESEARCH AND ADVANCE OF CHINESE TUINA
Ever since the founding of the People's Republic of China. tuina medicine has entered an overall new developing period. The main achievements of tuina study and advance in this period were embodied in the following five aspects:
1, Firstly， ancient books on tuina were excavated and sorted out, and a lot of new works on tuina were published. Besides the ancient books sorted out and published again, which were mostly specialized treatises on infantile tuina, in this period there were restricted publications: “Fixed Two-finger Medical Function” and “One-finger Treating as Spring Season”， etc., Which made contributions to the excavation of ancient Medical tuina books. New works on tuilla included the followings:
1), popular literatures which are of combination of basic theories with clinical knowledge.
2), Books in the form of clinical specialities.
3), Books which are of characteristic of schools or unique experience.
4), Specific treatises on manipulations or exercises.
5), Great complete works. Among them were “The Complete works of Anmo”, “Chinese Tuina”，”the Great Collection of Chinese Tuina”，etc. A general survey showed that all the works had the common features of the enhancement of science and logic of tuina. the breakthrough in tuina principle， the increase of proofs of modem researches and the combination of treatment of diseases with diagnostic and anatomic knowledge of Western medicine.
2, Secondly. the practice and summarization of clinical experience of tuina became more scientific day by day. The progress of science and culture and the development of health and medicine made tuina practice more scientific. The accumulated rich experience in practice and the education of modern medical knowledge raised the quality of massagists greatly. For example, diagnosis of tuina was no longer confined to the traditional four diagnostic methods. Many massagists have commanded modem medical techniques such as X-ray examination， ultrasonic scanning. electromyography examination, CT examination and nuclear magnetic resonance. In treatment sectarian bias were gradually thrown away. Massagists have mastered a set of theories of treatment based on syndrome differentiation. They are able to select and employ the best ones from the principles, methods, prescriptions and techniques. Thousands of theses on tuina have been published in many sorts of periodicals of China.
Which summed up tuina therapy from all respects scientifically and offered an important guide to tuina clinic.
3, Thirdly，the teaching system of tuina has been improving day by day. Since Shanghai Health SchooI started a tuina training class in October of 1956，tuina teaching has gone out of the old master-apprentice mode and has been on the way of formal education. Since the late 1970s, and early 1980s， all the TCM colleges in China have organized tuina specialty one after another and consummated the educational system of tuina subject including professional training. undergraduate， postgraduate， doctorate and international education， which have trained quite a lot of advanced specialists on tuina. Tuina teaching activities have been carried out at all TCM colleges of China and the foreign exchanges has greatly increased. Textbooks of tuina have also possessed different styles and different levels. With the development of tuina subject， tuina teaching has divided into different courses: basic tuina， tuina therapy，tuina manipulation. tuina exercise training, and infantile tuina, etc.
4, Fourthly，scientific researches into tuina has been advancing rapidly. Since the 1950s scientific researchers on tuina have conducted extensive clinicaI and experimental studies of the functional mechanism of tuina by means of modern scientific and medical knowledge and made exciting progress.
For instance, the gate control theory in neurophysiology was employed to successfully explain the analgesic principle of tuina. It was deduced that the distinct changes of circulating speed of blood and lymph- vascular fluid before and after tuina manipulations might be one of action principles of eliminating swelling and blood stasis with tuina. It was also demonstrated that lowering blood pressure by tuina had a stable effect， the contents of 5-HT in the blood increased after tuina treatment and the therapy of nipping the spine apparently promoted the absorption of the small intestine.
5, Finally， many new tuina therapies have been summed up and created such as ear point tuina, foot point tuina, the second metacarpal bone tuina， sports tuina and anesthesia by tuina. In a word, today's China is in the unprecedented golden age in the history of tuina. There appears a flourishing situation in tuina practice teaching. scientific research， publication of works and periodicals and the construction of tuina practitioners.
HOW TO LEARN CHINESE TUINA
Chinese Tuina is a clinical subject of TCM with intensive theory and practice. Tuina doctors should not only have the basic knowledge of Chinese and Western medicine， understand the methods of diagnosis and treatment based on syndrome differentiation, have specialized in theoretical knowledge of tuina. but also possess a good physical constitution and proficient manipulation techniques for clinical practice. So in addition to the study of elementary theories of Chinese and Western medicine. the students of tuina speciality must systematically study tuina courses and carry out strict constitutional physical exercise and technical training in manipulation.
In respect of medical elementary theories, the study of TCM theories of yin-yang, five elements, “zang-fu” organs, meridians， weiqi， ying, yang , and blood， cause and mechanism of diseases， four diagnostic methods and eight principles, differentiating syndrome to decide treatment and the study of anatomy, physiology, pathophysiology, pathoanatomy and physical diagnosis of Western medicine should be put at the first place. Anatomic structure of the human body， athletic physiology， neural segments， circulation of the fourteen meridians. Location and function of commonly used points have great practical value in tuina practice. Students should especially master them.