The Tui Na Touch
The Intensity of Chinese Medicine at Your Fingertips
By Vesna Vuynovich Kovach
Originally published in Massage Bodywork
magazine, April/May 2003.
Associated Bodywork and Massage Professionals. All rights reserved.
I am lying face down on a massage table. My ears are tightly covered, so that I'm deep inside a loud silence of rushing blood and muffled room tones. Explosions of pressure twang against the back of my skull and reverberate through my brain and being, over and over. I feel at first shaken apart, and then, oddly enough, powerfully relaxed -- safe.
What I'm experiencing is "drumming," one of the many moves native to tui na, or Chinese massage, the world's earliest recorded form of massage. The way it's accomplished is this: Cover the client's ears tightly with your palms. Press your two middle fingers firmly against the back of the client's head. Press your index fingers atop your middle fingers, sandwiching your middle fingers tightly. Now let your index fingers slip off the middle fingers, so they snap hard against your client's skull. Repeat.
According to Traditional Chinese Medicine (TCM) theory, this is good for ringing in the ear (tinnitus) and for hyperactive conditions like anxiety, attention deficit disorder and attention deficit hyperactivity disorder. So says the man who is providing my demonstration in tui na, Dr. Xiping Zhou, president and founder of the East-West Healing Arts Institute, Inc., a massage school in Madison, Wis. "It stimulates the parasympathetic nerve," Zhou says. "You can relax." The move is contraindicated for depression: "It brings (you) down too much."
But why all the drama? Why not just massage or press against the back of the head? "Covering the ears creates the seal, which makes the reverberations -- the echo in the head," explains Justin Polka, 28, who graduated from the East-West Healing Arts Institute in December 2002. A teacher for adults with developmental disabilities, Polka is making a career shift to therapeutic bodywork. At East-West, he gained a solid grounding both in a wide variety of Western styles of massage and in tui na, along with the attendant conceptual framework of TCM. Polka has supplemented his studies by assisting Zhou at his private acupuncture, tui na and herbal medicine practice.
Western massage is "more adapted to the pleasurable sensation of things," says Polka's classmate Eleni Tsioulos; the Eastern approach "is helping someone develop an active role in their own body." But she's glad to learn both styles. "They complement each other. Tui na can get a little intense and potent. You can rely on the Western to bring it back to that calm. But I like the idea of knowing you've done something, as opposed to just pleased someone," she says. Tsioulos, 23, had experience in herbal therapy, but massage was new to her when she began her studies.
The Eastern Way
A few moments later, I'm experiencing another set of surreal sensations: the back of my neck is being kneaded and grasped with upward motions that make my whole spinal column feel like it's floating, suspended, above the table. "In Western, they don't do this lifting," Zhou says. "They do the basic kneading and rubbing."
Tui na -- it literally translates to "pushing and grasping" -- is central to TCM, the comprehensive approach to healthcare that includes acupuncture, Chinese herbology and meditative exercises like tai chi chuan and qigong. This same body of knowledge underlies reflexology and Asian bodywork modalities like shiatsu and Thai massage. Scholars aren't sure exactly when Chinese medicine was first developed, but it probably dates back thousands of years before 500 BCE, the approximate date of the Neijing Suwen (a text sometimes translated as The Yellow Emperor's Classic of Internal Medicine), the first written compilation of what we now call TCM. One of the practices described in the Neijing Suwen is therapeutic massage, then called anmo (literally, "pushing and rubbing"). The term "tui na" came into use during the Ming Dynasty (1368-1644).
It's likely that most practitioners of alternative healing methods in the United States are familiar with at least the rudiments of TCM: An energy called qi (often spelled "chi") animates all life. Health depends on maintaining a balance of yin and yang, the complementary energies within qi. Qi courses through the human body along energy highways known as channels or meridians. By stimulating precise points along these meridians, other parts of the body that lie along the same meridians can be influenced, even though they might seem unrelated. That's how an acupuncturist can ease a stomachache by inserting a needle into certain points on a patient's hand, foot or leg.
Once not well respected, these Eastern ideas -- or at least the results of their practice -- are increasingly becoming accepted by mainstream Western medicine. In 1998, no less an authority than the National Institutes of Health pronounced acupuncture "an effective treatment" for a variety of conditions, clinically proven to relieve aches and pains and to control nausea resulting from chemotherapy. The NIH hasn't weighed in on TCM as a whole, but tui na is based on the same TCM principles as acupuncture.
Learning to view the human body according to the TCM paradigm was a challenge for Anne Stephenson, a licensed practical nurse of 22 years. "The Eastern way is a lot more abstract," she says. "Parts of it were hard to comprehend, because it's so against Western logic." Stephenson had quit her job, finding herself drawn to "the Eastern way of things" and seeking a way to recast her life. She discovered massage after a combination of acupuncture and tui na treatments healed her chronically aching neck. "This massage had the Eastern approach and the touch therapy I wanted," she says.
Last year, Stephenson started her own massage practice, Focused Touch, in Baraboo, Wisconsin. She remembers a client who'd had severe rotator cuff pain for six months: a single treatment ended the problem for good. "I used the tui na arm pull," Stephenson says. "You put their arm between your two arms, lining them up elbow to wrist. You hold on to the forearm and stretch it up in the air. The client is sitting on a chair, and you go up and down, up and down, three or four times." Another client came to Stephenson with a foot condition. "She used to wear orthotics. Now she can walk barefoot."
While Swedish-based Western massage forms are founded on an understanding of musculature, tui na follows from an understanding of the energy meridians. As a result, some of the key body areas in tui na are left more or less untouched in Western massage. For instance, TCM identifies dozens of individual points on the head, each with its own potential for healing. But in Western massage -- as in Western medicine -- these points don't have any particular importance.
A Systematic, Energetic Approach
Now Zhou uses his knuckle to press a point at the center of the top of my head, exerting steady pressure for about a minute. He identifies the spot as GV 20, the number 20 point on the governor meridian. GV 20 is also known as the "hundred energies meeting point," a point that's "very important to regulate the body's energy flow," he says. But in the Western view, "this is really nothing going to any muscle here. Nothing significant."
Then he climbs right up onto the massage table and grasps the parallel steel bars of a 6-foot-high frame around it. The frame is there specifically for the safe practice of walking massage: chai qiao.
The backs of my thighs burn sharply as Zhou treads on them. The pressure is so deep I feel it in my very veins. (Because it is so intense, chai qiao is not for children or the very elderly, or in general anyone in a frail condition.) I try to relax into the experience and not fight against it, remembering that Chinese massage is not about making the client feel good at the moment of treatment; it's the long-term results that matter. Nevertheless, I'm glad to discover that it feels pretty good when Zhou's feet walk carefully along the small of my back -- the power of an entire body directed into the toes, heels and soles moving and alive against my back, delivering more force more deeply than hands ever could. "This is very good for athletes," Zhou explains, "because of their big muscles. You use the hand, you won't go too deep sometimes."
Next, one foot, wedged in my armpit, pulls in the opposite direction from the foot on the back of my wrist. It's not what I'd call restful, but for my ever-tense shoulders and upper back, somehow it feels marvelous. I hear, "Ow!" It comes from me.
Within the vast scope of TCM, tui na is an extensive, complex system in its own right. Tui na techniques include pushing, dragging, "nipping," strong pinching, chopping, rubbing, and kneading, to name just a few. There's vigorous rolling using the knuckles and the back of the hand, "scrubbing" with the pinky finger side of the hand, applying pressure with the elbows, grasping at the back and spine with splayed fingers and interlocked thumbs, and brisk tapping with the cupped hands or edges of the palms. Deciding when to use any of these moves depends on a variety of factors. A tui na practitioner well versed in TCM theory can address the complete range of human pathology.
"What it adds for bodyworkers is a systematic, energetic approach. The use of points and meridians gives them a consistent paradigm," Bill Helm says. He's a longtime instructor of tui na, and one of its first practitioners in the United States. "There are a lot of adaptive systems using an energetic approach, but they're not systematic, in the sense that they're highly intuitive. They develop a lot of things on their own. With tui na, you get points and channels you can count on. They've been working for people for thousands of years."
For Western bodyworkers schooled in anatomy and musculature, TCM "just adds another dimension," he says. "And it doesn't contradict anything they've learned before." Helm is dean of allied studies at the Pacific College of Oriental Medicine and director of the Taoist Sanctuary, both in San Diego.
Erica Williams is a Western-massage-trained bodyworker who added tui na know-how to her personal toolkit after 10 years of practicing massage therapy at spas in San Francisco, Costa Rica, Mexico and her home town of Milwaukee. In Chinese massage, she discovered a whole new dimension to bodywork. "The techniques are very different from Western massage," Williams explains. "You're able to get into different ways to treat the problem area. The movements and techniques are really effective for certain problems. Carpal tunnel is a really good one. I can apply heat friction by rolling with my forearm against their forearm, wrist, hand and thumb pad."
Besides providing new ways to help her clients, Williams says tui na has been a boon to her own body. "My hands were getting burned out," she says. Now, instead of using "the typical Swedish moves -- thumb circles, kneading and using my fingers, I'll use rolling." A favorite move for a client's leg now is "rolling my forearm and wrist. With tui na, I can use my whole arm. The movements are more rapid and can wake the muscles up. Runners love it!"
Williams says she's looking forward to learning more tui na techniques. "I find it interesting and it works. That's all I can say -- it really works."
The Power of Integration
Bill Helm had been practicing tui na for 10 years when he first visited China in 1986. He was surprised to find there a matter-of-fact acceptance of massage as an indispensable healing tool with comprehensive applications. "It was a real eye-opener," he says. "It had the same status as acupuncture and herbs. I thought, 'Oh, this is its proper place.' "
The same integrative approach is taken towards combining Western medicine and TCM in China, where it's standard for a mix of TCM, TCM-and-Western and Western doctors to practice in concert. The 43-year-old Zhou is a combination doctor; his dual medical degree from Heilongjiang Medical University of Traditional Chinese Medicine fully licenses him (in China) to practice both Western medicine and TCM.
David Crain, a massage therapist who practices what he likes to call "a bizarre combination of Eastern and Western massage styles" at the Wellhouse Center in Windsor, Wis., visited Heilongjiang's hospitals on a three-week internship offered by Zhou. "Seeing how it works there was fabulous," Crain recalls. "The Eastern and Western doctors presented such a united medical front. The amount of time each doctor would spend with each patient was incredible. The treatments were more grounded, more thorough." While there, Crain received tui na treatment for a pinched nerve in his arm that had bothered him for years. "I hurt my arm working in a UPS warehouse," he explains. Chiropractic treatments had helped, but after tui na treatments, the years of chronic pain were finally resolved for good. "It was a very different style of manipulation," he remembers. "Definitely more painful than the chiropractic. Tui na is not necessarily the most comfortable thing."
"Tui na offers an alternative to acupuncture -- a therapy for aches and pains without any needles," Zhou says.
And there are still plenty of people who are scared of TCM -- the needles, the alien-ness of it all, David Milbradt says. Milbradt operates a private acupuncture and herbal medicine practice in Madison and he is a member of the faculty at East-West, where he teaches a course in the fundamentals of Oriental medicine. Some people might never dream of visiting a doctor of Chinese medicine, he says, but they just might visit a massage therapist to relieve some of their pain or to restore their feeling of well-being. If that massage therapist is armed with tui na, so much the better. "For some people, massage is more familiar," he explains. "It's a step they can imagine. Oriental massage opens up the chance to work with more therapeutic possibilities than relaxation." Another plus: massage involves "less liability" than acupuncture. It also takes less time and money to get an education and become licensed, and the practice itself is far less expensive to set up.
Milbradt speaks enthusiastically of tui na's potency. "Can you do as much with massage as with acupuncture? I think you can come fairly close," he says. "That's a good goal, to come as close as you can. But, will clients come to a massage therapist for the same range of diseases for which they'll turn to an acupuncturist? Obviously not."
Milbradt tells me that some of East-West's latest crop of students, inspired by the TCM theory they've learned here, have applied to acupuncture school. But for most, their East-West education provided exactly what they were looking for: a way to synthesize Eastern and Western approaches into their practice of massage.
Zhou is careful not to overstate the level of TCM education his school -- or any tui na curriculum in the United States today -- offers. A 751-hour program like East-West's can't impart as much theory as a full-time TCM institution in China that includes ongoing tui na instruction as part of its five-year program. The knowledge East-West gives its students is "more basic, like a Chinese medicine technician's skill," he explains.
Still, East-West is one of the institutions that can qualify students to apply for certification as an Asian bodywork therapist with the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). The NCCAOM is the organization that grants national certification in acupuncture and Chinese herbology; their new Diplomate in Asian Bodywork Therapy was added in 2002.
The Pacific College of Oriental Medicine is another school whose tui na grads qualify to take the exam that allows them to place the letters "Dipl. A.B.T. (NCCAOM)" after their names. Both Zhou and Helm are certified instructors with the American Organization of Bodywork Therapies of Asia (AOBTA), and both offer students the tools for a lifetime of tui na practice. But both also welcome massage novices and seasoned professionals who simply want to add some tui na to their practice -- a little or a lot.
This mix-and-match approach doesn't sit well with everyone. Barbra Esher, the Baltimore-based director of education for the AOBTA, says, "You really do a disservice to this 8,000-year-old tradition if you just take a couple of the elements. There's a big difference between adding the tweaks and twaddles to your practice and learning a whole set of treatment principles." Esher writes about Asian bodywork as a columnist for Massage Today. With tui na, she says, "You're not working on bones and muscles. You're working on 12 meridians, disbursing heat, or tonifying yang, or expelling a pathogenic factor, just to give some examples."
How does tui na fit in with the larger picture of bodywork in America today? "The way that it fits in is that people go and study the whole system," she says.
Zhou disagrees. "It's true, to become a good practitioner of TCM, you must learn it all -- the assessment, the culture, the theory, the philosophy. But if a Western massage therapist wants to just use some techniques, that's good, too. They can just take some courses. It's an additional asset."
He defends even the notion of putting isolated "tweaks and twaddles" to work. "This Chinese technique of skin rolling," he says, demonstrating with a broad, pinching motion, "it was developed 700 years ago for pediatric massage. It was introduced in America not long ago. Western therapists are already using it all over. It's very popular."
"I've been teaching for more than 20 years," Helm says. "I'm dealing with the reality of how it's used. You have some people who want to develop a TCM approach, closer to the acupuncture model. And a lot of students who are not interested in being primarily tui na. They're interested in specific therapeutic applications. A person is having problems with their shoulder, so you should do this. Swedish massage doesn't address that specifically. They break into tui na for 15 minutes, resolve the shoulder problem, and then go back to the Swedish massage.
"They're not looking to balance the person's energies. But the person does benefit. That's the nature of modern bodywork. It's eclectic."
In response to Esher's criticism of tui na theory and practice out of context, Helm invokes Taoist philosophy: "In a sense it's a disservice, but at the same time, as part of the Taoist tradition, it's a big change. What's important is to be harmonious in a situation."
In the past few years, Helm has seen tui na enrollment swell. "As bodywork in general matures more in this country, tui na practice and teaching will expand," Helm predicts.
"What I'm seeing more and more of is students coming for the tui na, not just the acupuncture. More people are becoming aware of the richness and the depth of it," he says. On the part of clients, "more people think of getting tui na, not so much for pampering, but for healing. If they're looking for healing, they go for Asian massage, with heavier pressure and more specific focus."
In recognizing the range and power of the ancient science of tui na, Americans are beginning to experience what's been known in China for millennia: Massage can be seriously therapeutic, not simply relaxing.
Vesna Vuynovich Kovach is a freelance writer in Madison, Wis., whose passion for natural living leads her to write about holistic health, sustainable agriculture, microbrewery beers, home cooking and other things that make life pleasant to live.