Chapter Four Tui-Na Techniques Before you start to practice Tui-Na, consider whether your partner has any conditions that are contraindicated. In particular: * Do not use Tui-Na on anyone with severe heart disease, osteoporosis, or cancer, especially of the skin and lymphatic system. * Do not massage directly on the lower back or abdomen of a pregnant woman. * Do not use Qi-points SP 6 or LI 4 during pregnancy. * Do not massage directly on inflamed or broken skin, eczema, psoriasis, or shingles. The techniques are presented in groups, such as squeezing, kneading, and pressing. Within each group there are variations; for example, for squeezing you can use the whole hand, the finger and thumb, or both hands interlocked. Many of the techniques have specific effects on underlying tissues, such as muscle relaxation, stimulation of blood flow, or lymph drainage.

The lymphatic system helps the body deal with infection and relies on such muscle movement to keep the lymph flowing. Some techniques act on Qi-points in the same way as acupuncture: releasing blockage, stimulating flow, and clearing stagnation. The most important benefits of the techniques are listed for each group. Whatever kind of massage therapy you practice, when you first start rubbing a tense, knotted muscle, it hurts. Only with repeated hard and concentrated rubbing will the muscle release its tension and pain subside. In Tui-Na, the Qi-points being massaged are often tender-- indeed, this is a good guide to their position--and initial kneading may be uncomfortable. Your partner needs to know this, and that Tui-Na uses strong physical forces to affect Qi-flow and joint function. Begin every technique with fairly gentle pressure and increase it gradually.

Talk to your partner throughout and be guided by any reaction. If there is pain, is it a "good" pain, or should you stop? Always be ready to reduce the pressure you use, or change to a gentler technique. Soft tissue techniques The soft tissue massage techniques all apply pressure to the underlying tissues--muscles, ligaments, tendons, and blood vessels. This pressure is applied in a variety of ways: at right angles to the body; in a circular motion; or with a shearing motion across the underlying muscle. Apply the pressure by leaning in to your working arm with your body weight. The amount of pressure can be varied enormously, depending on the part of your body you use, and the amount of body weight you lean in to the movement. To feel this, sit in an upright chair and press with your whole hand on your thigh. Then, without changing the amount of force you are using, move your hand so that you are pressing with just the thumb.

Using your thumb you are pressing over a smaller area, so the pressure is greater. If you rock the thumb over and back, keeping the end of it pressed on one point, or if you rotate the heel of the palm over a point, you apply a different kind of pressure again. Always start with gentle pressure and increase it gradually, releasing it equally gradually as you finish the technique. Pressing Pressing is basic to all Tui-Na techniques. Using the palm, the heel of the hand, the elbow, the thumb, and even the foot, a skilled therapist will apply precisely the right amount of pressure to the area being treated. When you use pressing, progress steadily from light to heavier pressure, guided by your partner''s response. Thumb Press This kind of press can apply the most concentrated pressure for a given force. If it hurts you to maintain strong pressure with the thumb, try using the tip of the elbow.

When even deeper pressure is required, press the free thumb down on top of the working one. Elbow Press This press concentrates the force on to the area being treated so that greater pressure can be applied. For gentler pressure use your upper forearm instead. Benefits of Pressing * stimulates the sense organs in the skin * aids Qi-flow through underlying tissues * stimulates the flow of lymph * stimulates Qi exchange between partners * relieves pain Kneading Kneading involves pressing with movement. Unlike rubbing, your hand (or elbow) must not slide on your partner''s skin. The kneading movement may be to and fro or circular, and is limited only by the looseness of your partner''s skin. A skilled therapist can create a range of different pressures delivered with subtle nuances of direction and force. Kneading can produce very gentle, relaxing pressure, or very deep stimulation.

The massage effect results from the skin moving with pressure over the underlying tissue. Thumb Kneading Here the thumb moves in a circle to apply a penetrating pressure; the rest of the hand supports the thumb. Thumb kneading applies a very concentrated stimulus to a Qi-point or a knotted area of soft tissue. Heel of the Hand Rock the heel of the hand to and fro, or move it in a circle. This technique covers a larger area than thumb kneading, but with less pressure. Benefits of Kneading * relieves tension in groups of muscles * assists the flow of blood * stimulates the drainage of lymph to help flush away toxins * assists relaxation Rubbing Rubbing involves movement over the skin surface, creating friction, which generates heat. It can vary from a very gentle to and fro movement to a vigorous scrubbing. Rubbing can be in a line or a circle, and involves larger sized movements than those used in kneading.

Palms in Opposition This technique gives a vigorous rubbing with the palms on both sides of arms, legs, fingers, thumbs, and shoulders. Begin at the top of a limb and move downward gradually. Upper Forearm Rub Here both forearms rub simultaneously in opposite directions. Use this technique on the back, covering the whole spine, and working from the center outward and back again. Give a push on the outward movement to effect a slight stretch. Benefits of Rubbing * generates warmth, stimulating circulation * promotes flow of Qi in surface tissues.