Area foundation routines
Area foundation routines have two important purposes. They provide you with a structure for learning to develop your Tui na skills and with a framework for creating Tui na treatments.
A structure for developing your Tui na skills
Practicing the area foundation routines will help you to develop your techniques and to learn how to adapt them to different parts of the body. They bring together a logical sequence of techniques that move through the adaptive, analgesic and dissipative stages of treatment.
I suggest that you learn them like a dance routine until one technique flows smoothly into the next and they feel like second nature. If you do, your confidence will grow and you will become fluid and coordinated in your application.
Once the sequences are second nature, you can concentrate on other aspects of your practice such as relaxation and softness, bringing Qi to your hands, developing sensitivity and directing your attention.
A framework for creating treatments
One of the most challenging aspects of Tui na is choosing what techniques to apply and where and how to apply them. The area foundation routines make this process more manageable by providing the foundations for creating and building up Tui na treatments. The routines provide a framework, which can be utilized and adapted. Techniques and points can be added or removed, and particular aspects of a routine can be focused on according to the requirements of treatment.
Note-taking is also made easier. Instead of writing down every single technique that you want to apply, which would be very time-consuming, you can refer to the area routines that you want to use and note what you focused on, added or removed. For example, you may say that you applied the chest routine, focusing on gentle Tui fa and Rou fa in the intercostal spaces.
Health maintenance treatments
You can provide excellent preventative and health maintenance Tui na treatments by linking the area foundation routines together and following the general principles of treatment on page 130.
There are several versions of area routines. This is because every experienced practitioner and teacher will have developed their own variations along with their style of practice.
In the rest of this chapter, I have provided foundation routines that will help you to develop a broad range of techniques and become familiar with working through the three stages of treatment. As you gain experience and develop your own style of practice, you can, if you wish, experiment with creating your own foundation routines. Just remember to follow the three stages of treatment.
The area foundation routines I describe are:
•The head and face
•The neck and nape
•The back
•The upper limb
•The lower limb
•The chest and hypochondrium
•The abdomen
Head and face
The head routine is applied with the patient seated.
The techniques applied to the head should be performed over a cotton Tui na cloth unless the patient has very short hair in which case you can apply them directly to the head.
1. Tui fa and Mo fa
Stand in front of your patient supporting the back of their head with one hand. Bring Qi to your other hand and apply Tui fa and then Mo fa from the anterior to the posterior hairline using your palm and fingers. Work the left side of the head first, then the right and finally the center. Start slowly and gradually increase your speed.
Alternate between these two techniques until the patient’s head feels hot.
2. Rou fa
Stand behind your patient, interlace your fingers and apply Rou fa to Fengchi GB20 using the minor thenar eminence of both hands.
3. Compound technique: grabbing–grasping
Grab and grasp the five channels of the head, from the anterior to the posterior hairline, about 10 times.
4. Ma fa
Apply Ma fa with your thumbs from the temporal hairline in front of your patient’s ears to the mastoid process. Work gradually backwards and forwards several times until the area feels hot.
5. Pai fa
Using a loose fist or the palm of your hand, apply Pai fa to Baihui Du20 10 times.
The face routine is applied with the patient lying supine.
1. Tui fa
Using the palms of your hands, apply Tui fa gently to stroke your patient’s forehead and temple area.
Using your thumbs alternately, push from Yintang to Shangxing Du23.
2. Ma fa
Wipe back and forth with your thumbs in horizontal lines from the eyebrows to the anterior hairline.
3. Compound technique: pinching–grasping
Pinch and grasp the eyebrows between your thumbs and index fingers from medial to lateral three times.
4. Yi zhi chan tui fa
Apply moving Yi zhi chan tui fa in a figure-of-eight around the eyes 6–10 times.
5. Rou fa
Knead Yintang and Tai Yang with your middle fingers.
6. An fa, Rou fa and the compound technique, kneading–pinching
Stimulate Zanzhu BL2, Benshen GB13, Yangbai GB14, Sibai ST2, Juliao ST3, Daying ST5, Touwei ST8, Yingxiang LI20, Renzhong Du26 and Chengjiang Ren24 using An fa and Rou fa or kneading–pinching, until the points are warm and slightly sore.
7. Ma fa
Using your index and middle fingers, wipe back and forth briskly from LI20 to BL2 until the area is very warm.
8. Compound technique: pinching–grasping
Pinch and grasp along the jaw line from Ren24 to Jiache ST6 using both hands, three times.
9. Rou fa
Knead underneath the jaw with your fingertips and knead the masseter muscle with your major thenar eminence at the same time. Apply to each side three times.
Apply light, brisk Rou fa with your thenar eminence to the jaw, cheeks, temples and forehead until warm.
10. Compound technique: kneading–pinching
Knead and pinch the ears, then lift and pull both ears three times.
11. Gua fa
Gently scratch the scalp with the tips of your fingers and/ or nails along the anterior hairline from left to right and right to left three or four times.
To finish
Warming palm
Finally, rub your hands together until scorching hot, and then bring them over your patient’s eyes, ears or temples according to their presenting disharmony. (Refer to p. 135 using breath and visualization for more ideas.)
The foundation routine for the head and face has a soothing, relaxing effect, and in my experience, patients love it. It can be applied to calm the Shen, expel Wind, disperse obstructed Wei Qi, improve vision, clear the sinuses, alleviate pain, and facilitate and regulate the rising of clear Yang.
With the addition of appropriate distal work, work on the back, chest, abdomen, and so on, this routine provides a very useful basis for the treatment of problems such as:
•Headaches and migraine
•Insomnia
•Stress
•Anxiety/depression
•Ear, nose and throat (ENT) problems
•Sinusitis
•Allergic rhinitis
•Dizziness
•Facial paralysis
•Tinnitus
•Toothache
Neck and nape
The neck and nape routine is applied with the patient seated.
Adaptive level
1. Tui fa
Support your patient’s forehead with your non-dominant hand and apply Tui fa with your dominant hand using the tips of your index, middle and ring fingers. Work in lines from Fengfu Du16 to Dazhui Du14, Tianzhu BL10 to Dazhu BL11 and then using both hands from Fengchi GB20 to Jianjing GB21. Apply each about 5–10 times.
2. Rou fa
Apply Rou fa along the same lines as Tui fa above using your thenar muscle 3–5 times. Then using your thumb apply Rou fa between each of the cervical vertebrae, then just to one side of the vertebrae and then down the Bladder and Gallbladder channels of the neck.
Apply Rou fa with the heel of your palm all over the nape, top of the shoulders, scapula and the upper back until the muscles feel warm.
Analgesic level
3. Gun fa
Apply Gun fa all over the top of the shoulders, nape, the back and sides of the neck, incorporating some passive movements of the neck as you work. Apply for about 10 minutes.
4. Yi zhi chan tui fa, Ji fa, Zhen fa or An fa
Select a couple of local points to be stimulated, such as BL10, GB20, GB21, Jianzhongzhu SI15 and stimulate for 2–3 minutes using one or two of the above techniques.
5. Na fa
Knead and grasp the neck, from the occiput to the root of the nape several times. Pinch and grasp either side of the neck from BL10 to BL11 three times on each side. Knead and grasp gently along the sternocleidomastoid muscle three times on each side. Lift and grasp the top of both shoulders (GB21 area) briskly for about a minute.
6. Rou fa
Knead the patient’s throat gently with the pads of your thumb and fingers several times, working along the sternocleidomastoid, the Stomach and Large Intestine channels.
Passive movements
7. Ba shen fa
Apply Ba shen fa to the neck three times remembering to work with your patient’s breath. Apply kneading and grasping between each stretch.
8. Yao fa
Rotate the neck. Remember to start gently with small rotations and gradually increase the range of the movement. Do this in both directions.
Dissipative level
9. Pai fa, Ji dian fa and Ji fa
Apply loose fist Pai fa or five-finger Ji dian fa to the patient’s neck and nape and Ji fa to the nape and top of both shoulders.
10. Whisking–sweeping
Whisk and sweep the nape, shoulders and upper back.
To finish
Warming palm
Finally, rub your hands together until scorching hot, and then bring them to the top of your patient’s shoulders. (Refer to p. 135 using breath and visualization for more ideas.)
With the addition of appropriate distal and local points, this routine provides a useful basis for the treatment of problems such as:
•Restriction of neck movement, muscular tension, sprain, wry neck
•Cervical spondylosis
•Wind-Cold-Damp Bi syndrome
•Headache/migraine
•Insomnia
•Stress
•Anxiety/depression
•ENT problems
•Sore throat/hoarseness/vocal problems
Remember that for problems in the neck, you will need to work in the arm. Try applying the foundation routine for the upper limb before the neck and nape routine.
Back
The back routine is applied with the patient lying prone.
Adaptive level
1. Tui fa
Push with your palm along the Governing Vessel from Du14 to the coccyx. With both palms or the heels of your palms, move down the Bladder channel from the nape to the sacrum. With one palm, move across the Bladder channel pushing from the spine out to the sides of the body, working down gradually from the nape to the sacrum. Do each of these several times until the patient’s back becomes warm.
2. Rou fa
Knead along the Governing Vessel and the Bladder channel from nape to sacrum with your whole palm or heel of your palm 3–5 times.
For variation, apply pinching–grasping or kneading– grasping to the top of the shoulder nearest to you and Rou fa along the Bladder channel on the opposite side.
Analgesic level
3. Gun fa
Apply Gun fa along the Bladder channel working up and down between the nape and the sacrum for about 10 minutes.
4. An fa/Ya fa and Rou fa
Press, suppress and knead with your thumbs or elbow along the Huatuojiaji points and the inner and outer lines of the Bladder channel from top to bottom. You can work the whole back or pick out particular points.
5. Ya fa
With one hand on top of the other and the power coming from both hands, suppress with your palms from the nape to the sacrum on either side of the spine. Work slowly, asking the patient to breathe slowly and deeply; let your hands follow their breath, suppressing with the patient’s exhalation. This should feel soothing and relaxing.
Suppress the sacrum three times using the heel of your palm or forearm.
6. Rou fa
Apply Rou fa to the lower back, sacrum and buttocks using your forearms and the heels of your palms.
7. Tui fa
Using a little toasted sesame oil, dong qing gao or other suitable massage medium, apply Tui fa with your elbow from the nape to the sacrum, working just to one side of the spine along the line of the Huatuojiaji points 3 times on each side.
With one palm on top of the other, apply strong pushing with the heel of your palm from Shenshu BL23 to Zhibian BL54.
Dissipative level
8. Ji fa and Pai fa
Apply Ji fa and Pai fa from the nape to the sacrum either side of the spine. Apply Pai fa with a hollow palm over the spine.
9. Whisking–sweeping and Ji fa and Pai fa
Either alternate between whisking and sweeping and the striking techniques or use in combination as a coordinated technique working all over the back.
10. Ca fa
Apply Ca fa to the Bladder meridian either side of the spine, across the tops of the shoulders and across the lumbar and sacral areas using dong qing gao, woodlock oil or another suitable massage medium.
Passive movements
11. Ban fa
Apply supine or lateral twist Ban fa as an end-of-range stretch without force.
Supporting the kidneys
12. Rub your palms until scorching hot and place over Shenshu BL23. On your in breath, draw Qi in through Baihui Du20 into your Dantian, and on your out breath, release the Qi through Laogong PC8 into the patient’s kidneys. Work like this for about 3 minutes.
Upper limb
The upper limb routine is applied with the patient seated.
Adaptive level
1. Tui fa
Push with your palm along the arm Yang and Yin channels from the shoulder to the hand, working with or against the flow of Qi depending on your diagnosis, until warm.
2. Rou fa
Knead with your palm or the heel of your palm, working gradually along the channels, Yang first and then Yin. Pay attention to the shoulder, elbow and wrist joints as you come to them.
3. Compound technique: holding–grasping
Hold and grasp 3–4 times from shoulder to wrist.
Analgesic level
4. Gun fa
Apply rolling to the shoulder joint and upper arm with one hand while the other hand supports the patient’s arm and applies gentle rocking and twisting passive movements. Continue rolling gradually up and down the arm from shoulder to wrist focusing on the elbow joint when you come to it.
5. An rou fa
Press and knead with your thumb the major points around the shoulder, elbow and wrist such as Jianzhen SI9, Tianzong SI11, Jianyu LI15, Jianliao TE14, Quchi LI11, Shousanli LI10, Chize L5, Xiaohai SI8, Waiguan SJ5, Neiguan PC6, Yangchi SJ4, Yangxi LI5 and Hegu LI4.
6. Compound versions of Na fa and Rou fa
Working along the Yang and Yin channels between the shoulder and the wrist, apply kneading–grasping, pinching–grasping, plucking–grasping, nipping–grasping and kneading–nipping. Work into fossas and points and places where channel sinews bind.
7. Nian fa and Rou fa
Apply holding and twisting to each finger three times and then Rou fa to the arm Yang channel Well points.
Dissipative level
8. Cuo fa
Rub roll the shoulder and then all the way down the arm three times then rub roll the palm.
9. Dou fa
Holding just above the wrist, apply Dou fa to the arm three times.
10. Pai fa, Ji dian fa and Ji fa
Apply loose fist and hollow palm Pai fa to the shoulder joint and up and down the Yang and Yin channels. Apply Ji dian fa around the joints and to areas of adhesion and holding. Apply Ji fa chopping between each of the patient’s fingers.
Passive movements
11. Yao fa and Ba shen fa
Apply Yao fa and Ba shen fa to the shoulder, elbow, wrist and fingers.
12. Ban fa
Apply forward and backward extension Ban fa to the shoulder as a passive end-of-range movement stretch three times.
To finish
13. Ca fa
Using a massage medium such as woodlock oil, apply Ca fa to the shoulder joint using both hands on either side of the joint. Do the same with the elbow joint and then apply to the whole of the upper limb along the Yang and Yin channels.
14. Warming palm
Finally, rub your hands together until scorching hot, then hold a joint or another area that needs some support and Qi between your hands. (Refer to p. 135 for more ideas on using breath and visualization.)
Most of this area foundation routine could also be applied with your patient lying down supine. Make adjustments to the techniques according to the position.
This routine provides a framework that is useful to apply as either a way into treatment or as part of treatment for problems such as:
•Bi syndromes and traumas affecting the joints, muscles and tendons of the upper limb, for example frozen shoulder, tennis elbow, carpal tunnel syndrome, repetitive strain injury (RSI), cervical spondylosis, wry neck
•Chronic neck and shoulder tension
•Problems affecting the chest such as palpitations, chest Bi syndrome, cough and asthma
•Headaches and ENT problems
The upper limb can be used as a passageway for dredging and draining pathogenic factors and stagnant Qi from held emotions that are affecting the upper part of the body.
Lower limb
Begin the routine with the patient lying prone.
Adaptive level
1. Tui fa
Push with your palm along the Bladder and Gallbladder channels from the buttocks to the toes until warm.
2. Rou fa
Knead with your palm or the heel of your palm, working gradually along the Bladder and Gallbladder channels.
3. Compound technique: holding–grasping
Hold and grasp along the Bladder channel 3–4 times from the buttocks to the ankles.
Analgesic level
4. Gun fa
Apply Gun fa along the Bladder channel from the buttocks to the ankles. Work up and down the leg several times, increasing your depth and power gradually. You can also incorporate passive flexion and extension of the knee joint while applying Gun fa to the gluteal area.
5. Ya fa
Using your palm or the heel of your palm, apply Ya fa to the Bladder channel from the buttocks to the ankles. Then apply elbow Ya fa and Rou fa to Zhibian BL54, Huantiao GB30, Chengfu BL36, Yinmen BL37 and Chengshan BL57.
6. Compound technique: pushing–pressing
Using both thumbs, push and press Weizhong BL40.
7. Compound technique: kneading–grasping
Work along the Bladder and Gallbladder channels from the buttocks to the ankles with kneading–grasping. Work into fossas and points and places where the channel sinews bind.
Knead and grasp either side of the Achilles tendon to stimulate Kunlun BL60 and Taixi KD3.
8. Compound technique: pinching–grasping
Pinch and grasp along the Bladder channel from BL40 to Zhiyin BL67.
9. An fa
With your patient’s lower leg supported either on your own thigh or on pillows, apply An fa to the heels and soles of the feet using your knuckles.
10. Ca fa
Scrub Yongquan KD1 with your knuckles until scorching hot.
11. Nian fa
Hold and twist each toe three times.
Dissipative level
12. Pai fa and Ji fa
Apply Pai fa or Ji fa from the buttocks to the ankles.
13. Compound technique: whisking–sweeping
Whisk and sweep briskly along the leg.
Now ask the patient to turn over so they are lying supine and continue.
Adaptive level
14. Tui fa and Rou fa
Push and knead along the Stomach channel and along the Spleen, Liver and Kidney channels until warm.
Analgesic level
15. Gun fa
Apply Gun fa to the Stomach channel working from Biguan ST31 to Jiexi ST41.
16. Compound technique: pinching–grasping
Pinch and grasp along the Stomach channel and along the Yin channels of the leg, focusing on major points along the way.
Dissipative level
17. Pai fa
Knock with your palm or a loose fist along the Stomach channel and the Yin channels of the leg.
18. Ca fa
Scrub along the Stomach channel and the Yin channels, focusing the technique around the medial and lateral sides of the knee.
Passive movements
19. Yao fa
Perform Yao fa on the hips and ankles.
20. Ba shen fa
Use Ba shen fa to extend the legs and stretch the joints. Hold the patient’s ankles and raise both legs up simultaneously. Use your body weight to apply the stretch by leaning backwards. While maintaining a gentle stretch, swing the patient’s legs from side to side and circle the legs clockwise then anti-clockwise a few times.
21. Duo fa
Holding the patient’s ankle, perform Dou fa on each leg.
This foundation routine for the lower limb will help to lubricate the joints, relax and release the leg channel sinews, activate and invigorate the circulation of Qi and Blood, dredge and expel pathogenic factors and stop pain. It can provide a framework for treatment of various problems including:
•Bi syndromes such as osteoarthritis and rheumatoid arthritis
•Traumas affecting the joints, muscles and tendons of the lower limb
•Sciatica
•General muscle pain
•Atrophy of the leg muscles
•Back problems – working on the lower limb is essential
The lower limb can be used as a passageway for dredging and draining pathogens and stagnant Qi that are affecting the lower part of the body.
Chest and hypochondrium
The chest and hypochondrium routine is applied with the patient lying supine.
Adaptive level
1. Tui fa
Push with your palm across the chest from the sternum to the Zhongfu LU1, Yunmen LU2 area. Work one side then the other. Push from Tiantu Ren22, Shanzhong Ren17 using either the pads of three fingers or the heel of your palm. Push across the ribs with both palms working from the midline out.
2. Rou fa
Knead with your palm or the heel of your palm all over the chest, ribs and down the Yin channels of the arms.
Analgesic level
3. An fa, Rou fa and Ma fa
Press and knead Ren17 and LU1 with your thumb.
Press and knead the intercostal spaces with both of your thumbs, working from the midline out and working down to the level of the 3rd or 4th intercostal space, pressing and kneading each place several times. After pressing and kneading each intercostal space, apply Ma fa briskly back and forth.
4. Compound technique: kneading–grasping
With your thumb in the LU1 area and your fingers in the axilla, knead and grasp the lateral side of the greater pectoral muscle several times on both sides.
5. Compound technique: pushing–pressing
Apply pushing–pressing to the subclavicular fossa.
Dissipative level
6. Ji dian fa and Zhen fa
Apply light dotting to the chest along the Ren, Kidney and Stomach channels and in the LU1–2 area. Apply Zhen fa either with your middle finger or palm to two or three major points of the chest such as Ren17, Shufu KD27 and LU1.
7. Pai fa
Apply palm or loose fist knocking to the flanks and lower ribs.
8. Zhen fa
Apply palm Zhen fa to the lower ribs over the area of Qimen Liv14.
9. An fa to open the lungs
Put one hand on top of the other. Ask your patient to breathe in; on their out breath, press their chest with a pumping action, gradually increasing the pressure until they have completely exhaled. Release the pressure as your patient breathes in. Do this three times on the chest, and then repeat the same action on each side of the ribcage, encouraging your patient to expand their ribcage when they inhale.
10. Ca fa
Using an appropriate massage medium, scrub across the chest, along the flanks and across the lower ribs using either your minor thenar eminence or your palm.
11. Cuo fa
Ask your patient to sit up on the treatment couch. Apply rub rolling to their ribcage 3–5 times.
To finish
Warming palm
Rub your hands together until scorching hot and apply to points or areas of the chest or ribs that need the most support. (Refer to p. 135 for more ideas on using breath and visualization.)
The foundation routine for the chest and ribs soothes Liver-Qi, descends rebellious Qi, moves stagnation, opens the chest, promotes expectoration of Phlegm, strengthens Lung-Qi, tonifies the Upper Jiao and the Sea of Qi of the chest, benefits the diaphragm and aids respiration and calms the Shen.
With the addition of appropriate distal work, work on the back, abdomen, head and so on, this routine provides a very useful basis for the treatment of problems such as:
•Chest pain
•Asthma
•Cough
•Palpitations
•Hypochondriac pain
•Epigastric pain
•Plum stone throat
•Migraine
•Irritable bowel syndrome (IBS)
•Premenstrual tension (PMT) and menstrual problems
•Insomnia
•Stress/depression/anxiety
Abdomen
The abdomen routine is applied with the patient lying supine.
Adaptive level
1. Tui fa
Push with both palms from just below the ribs to the upper border of the pubic bone. Imagine drawing a line with your Laogong PC8 along the patient’s Stomach channel. Do this until the belly becomes warm.
Tui fa can be applied with one or both palms to any of the channels that move through the abdomen, pushing with or against the flow of Qi according to your treatment principle.
2. Mo fa
Round rub the abdomen with the palm of one hand 36 times clockwise then 36 times anti-clockwise to harmonize the digestion. If the patient is constipated, work in a clockwise direction. If they have diarrhea, work anti-clockwise.
3. Rou fa
Knead Zhongwan Ren12, Tianshu ST25 and Qihai Ren6 with the palm of your hand until warm.
Analgesic level
4. Local point stimulation with An fa and Rou fa or Yi zhi chan tui fa
Press and knead ST25 with your thumbs, working both points at the same time. Then apply Yi zhi chan tui fa, or An fa and Rou fa to Ren12, Zhangmen Liv13 or other suitable points according to your diagnosis. Stimulate each point for about 3 minutes.
5. Coordinated technique: forearm Rou fa and Gun fa
Apply forearm Rou fa to the abdomen, concentrating on the areas of Ren12 and Shenque Ren8, and Gun fa with your other hand along the Stomach channel of the leg.
6. Cat’s paw An fa
Put the palms of both hands in a horizontal line across the abdomen at the level of the navel. Create a wave-like motion, pressing from the heel of your right palm through to the fingers and then passing the wave to the heel of your left palm. Imagine that you are gradually and smoothly rolling a ball that is inside the patient’s abdomen from side to side. Think of a cat kneading a blanket. This motion helps to harmonize the intestines.
Dissipative level
7. Compound technique: lifting–grasping
Lift and grasp the abdomen, working along the channels. Lift and grasp and roll the flesh back and forth between your fingers or lift, grasp and jerk to the left and right and release.
8. Zhen fa
Vibrate with your right palm over the navel, ST25/Daheng SP15 and Ren6/Guanyuan Ren4.
9. Pai fa
Knock the abdomen with a cupped palm.
To finish
Warming palm
Rub your hands together until scorching hot and apply to points or areas of the abdomen that need the most support. (Refer to p. 135 using breath and visualization for more ideas.)
The abdominal routine strengthens the Spleen and Stomach, tonifies Qi, harmonizes the Stomach and Intestines, harmonizes the Middle Jiao, moves stagnation, warms the Kidneys, and regulates the function of the Ren and Chong Mai.
With the addition of appropriate distal work, and work on the back, chest and ribs, this routine provides a very useful basis for the treatment of problems such as:
•IBS
•Constipation
•Diarrhea
•Epigastric pain
•Abdominal pain
•Indigestion
•Poor appetite
•Belching and flatulence
•Painful periods
•Irregular menstruation
•Amenorrhea
•Fibroids
•PMT
•Infertility