Headaches and hypertension
Headaches
Headaches are one of the most common symptoms that you will come across in practice. Some patients come for treatment with headaches as their main complaint, as is the case with migraine. They are frequently associated with a variety of ailments such as common colds, sinus problems, hay fever, digestive disorders and muscular skeletal problems.
Tui na is great for headaches; it can bring on-the-spot relief and, in the case of chronic headaches and migraine, regular treatments can produce excellent results.
There are many types of headache and the causes of these are wide and varied. A common 21st century cause is tension and stagnation of Qi in the Yang channel sinews due to stress, emotional holding patterns, excessive computer use and lack of appropriate exercise.
In the case of migraine which seems increasingly common, especially among women, there is a often a combination of stagnation and tension, usually in the Tai Yang and Shao Yang channel sinews, plus Deficiency of Blood and Yin and, consequently, rebellious Yang Qi rising.
In my practice I have found the most common headaches are those related to tension and stagnation of Qi in the Yang channel sinews of the neck, shoulders and back, digestive disharmonies leading to Qi stagnation and the production of Damp and Phlegm, Deficiency of Qi and Blood and Liver-Yang rising due to Deficient Liver-Blood or Liver/Kidney-Yin Xu.
Depending on your diagnosis of the underlying disharmony, Tui na treatment usually involves a combination of several elements, the most common being:
•Releasing the Yang channel sinews, expelling external pathogenic factors and moving and dispersing obstructed Wei Qi
•Strengthening and invigorating Qi and Blood and enabling clear Yang to rise
•Soothing Qi and soothing the Liver
•Nourishing Blood and Yin
•Tonifying the Kidneys
•Harmonizing the Middle Jiao and the Stomach and Intestines
•Tonifying the Spleen, dredging and eliminating Damp and Phlegm
•Descending rebellious Qi
General tips for treating headaches
•Take your time to palpate for tender local points and areas of holding and adhesion, particularly along the Tai Yang and Shao Yang channel sinews in the patient’s neck, nape, shoulders and paraspinal muscles. Stimulate the most tender points with appropriate techniques and release the sinews as you come to work in the affected areas.
•At the beginning of treatment, do some work on the patient’s head and face using the basis of the foundation routine for the head and face. Return to the local work at the end of the treatment.
•Release the neck, nape and shoulders and stimulate any relevant points in these areas.
•If necessary, do any work on the back next; for example, release stagnation and adhesion, stimulate relevant points such as Back Shu, Governing Vessel and Huatuojiaji points, and apply any nourishing Yin style work on the back such as tonifying the Kidneys.
•Work along relevant arm and leg channels. For example, if the patient has a Yang Ming frontal headache, work along the Stomach and Large Intestine meridians; if there is also Damp present then you may also be working on the Spleen and Lung Tai Yin channels. Stimulate your chosen distal points as you work along the channels.
•Do some work on the chest if the headaches are related to Damp, Phlegm, rebellious Qi, Wind invasions or Liver-Qi stagnation.
•Work on the abdomen for headaches related to digestive disharmony and for Qi, Blood and Kidney Xu.
•Work locally on the face and head to finish.
The treatment foundation routines for both the head and face and the neck and nape form an excellent framework for effective local work in the treatment of headaches. If the headaches are coming from an underlying Deficiency, the local work should be applied gently, taking your time over each part. If the headache is due to Excess, create stronger stimulation and apply the techniques briskly for a shorter period of time. In addition to this, add relevant points and techniques that may be applicable to the disharmony.
To help you plan a Tui na treatment for headaches, see Table 14.1 for some suggestions of useful techniques to consider including in the treatment of common patterns of disharmony.
Migraine exercise to show to patients
If done at the first signs of a migraine before the headache has come on, this can stop it developing fully. Sit in a quiet place on an upright chair. Take off your shoes and socks and put your feet flat on the floor. Keep your spine straight and place the backs of your hands on your thighs, fingers relaxed. Imagine a thermometer in each hand, and your palms becoming red hot. Try to make the gauge reach maximum. Think of heat moving down your arms from your head to your palms. Do this for about 5 minutes, then stimulate Liv3 and LI4 with Rou fa or pinching–grasping for several minutes on each side until the points ache strongly. Follow this by drinking a glass of water.
Headache case studies
Headache
Main complaint
Izzy, aged 15, was brought along for treatment by her Mum who I was treating for digestive and sinus problems at the time. She had been having a lot of headaches recently, at least once a week, and had fainted a couple of times at school. Her headaches were always on her forehead and were dull in nature; they were particularly bad the week after her period and when she was tired. They were better for rest. She had a poor appetite; I already knew from her Mum that Izzy did not eat well; she would not eat breakfast and often only had a sandwich or some chips for lunch at school; she had been vegetarian for the previous 2 years and ate very little fresh food. She was finding it difficult to concentrate at school and her Mum told me that she had become increasingly uncommunicative which was out of character. Izzy was very keen on sport and led a very busy life with lots of after-school activity.
Secondary complaints
Izzy’s periods started when she was 12. Over the previous 18 months her periods had been very heavy; they lasted for 7 days and often they were painful at the beginning. She felt completely drained during and after her period, and had fainted towards the end of her last two periods.
Presenting disharmony |
Useful treatment techniques |
Wind-Cold |
Gua sha or cupping along the Yang channels of the neck, nape and back Gua fa along the Governing Vessel and Bladder channel Tan bo fa and Na fa to the Bladder channel sinew in the neck, nape and back Kneading and nipping to Well points and Governing Vessel points Pinching–grasping the area of GB21 Clockwise palm Rou fa on Ren4 Ca fa on the back along the Bladder channel and across BL23 Yi zhi chan tui fa, anti-clockwise Rou fa and strong pinching–grasping for point stimulation |
|
Wind-Heat |
Gua sha or cupping along the Yang channels of the neck, nape and back Gua fa along the Governing Vessel and Bladder channel Nipping–grasping and kneading–nipping along the Governing Vessel and for stimulating points such as Du14, LI11 and GB20 Ca fa on the back along the Bladder channel Dredge the Yang channels with Na fa and Tui fa |
|
Wind-Damp |
Gua sha or cupping along the Yang channels of the neck, nape and back Pinching–grasping the Bladder channel sinew in the neck, nape and back Single-finger Ji dian fa on local head points, i.e. ST8, Du23 and Du20 Dredge the Yang channels with Na fa and Tui fa Pai fa and joined palm Ji fa to the back and limbs Zhen fa, Ji dian fa and Ca fa on the chest Palm Rou fa on Ren12 |
|
Liver-Yang rising |
Gua sha along the Governing Vessel from Du16 to Du4, the Bladder channel from BL10 to BL23 and the Gallbladder channel from GB20 to GB21 Tui fa, Rou fa and kneading–pinching along the same channels Lifting–grasping along the spine from Du14 to the sacrum An fa on BL18 with intention on descending Qi and soothing Liver The basics of the chest and hypochondrium routine with an emphasis on Tui fa, Rou fa and pushing–pressing the supra- and infraclavicular fossas An fa on ST12 with the intention of descending Qi Tui fa to KD1 Ba shen fa to the neck Gua fa and Ma fa to the sides of the head Kneading–grasping and pulling the ears |
|
Turbid Phlegm obstructing |
Gun fa to the shoulders and back Ji dian fa and Yi zhi chan tui fa to the Back Shu points Forearm Rou fa to BL20 Forearm Rou fa over Ren12 and Ren6 coordinated with Gun fa, Pai fa and Ji dian fa down the Stomach channel Kneading–nipping PC6 with single-finger Ji fa on ST40 Apply the basic routine for the chest with an emphasis on An fa, Rou fa, Zhen fa and Ji dian fa; Rou fa or Zhen fa on Ren22 Pai fa and joined palm Ji fa on the back and limbs |
|
Qi Deficiency |
Tui fa, palm Rou fa and lifting–gasping along the Governing Vessel from the sacrum to the nape Clockwise Rou fa to stimulate Du4, Du14 and Du20 Pai fa to the vertex Ca fa to Du4 and Du14 Palm Rou fa, Mo fa and figure-of-eight Tui fa over the relevant Back Shu points Tui fa, Rou fa and Ca fa along the relevant Yin and Yang channels in the arms and legs Point stimulation with An fa, clockwise Rou fa and gentle Yi zhi chan tui fa Yin style holding and joining points such as ST36 and Ren12, LU9 and Ren17 Rou fa and tai chi Mo fa on the abdomen Warming palm, work with intention and holding over major points, Deficient organs and the affected areas on the head; work with breath and visualization Direct moxa to tonify points Indirect moxa to stimulate Du20 to raise the Yang |
|
Blood Deficiency |
Forearm Rou fa and palm Rou fa over BL14, BL17, BL20 and BL23 Figure-of-eight Tui fa around the relevant Back Shu points Gentle Tui fa, An fa and Rou fa on the chest Yin style holding and joining points Tui fa, Mo fa, Rou fa and Na fa along the Spleen, Liver, Lung and Pericardium channels focusing on the Ying Qi level Warming palm, work with intention and holding over major points, Deficient organs and the affected areas on the head; work with breath and visualization Tai chi Mo fa on the abdomen Palm Rou fa and Zhen fa over Ren4 Direct moxa to tonify points |
|
Kidney Deficiency |
Tui fa, Rou fa and Ya fa with the palm along the Bladder channel from the nape to the toe Moderate Gun fa for about 20 minutes along the Bladder channel concentrating on the lower back around the Kidney Back Shu points Forearm Rou fa, figure-of-eight Tui fa and Mo fa over BL23 and BL52 Ca fa over BL23 and BL52 Tui fa, Mo fa, Rou fa and Ca fa along the Kidney channels of the legs Forearm or palm Rou fa and Zhen fa to Ren4, Ren6 or Ren8 Warming palm over the kidneys, the back of the head and over the eyes |
Palpation and observation
Izzy was incredibly pale and looked very tired when I saw her initially.
Tongue
Her tongue was pale with orangey sides.
Pulse
Her pulse was Deep, Thready and Weak.
Diagnosis
The diagnosis was Qi and Blood Xu.
Treatment principle
This was to nourish Blood, invigorate Qi and raise Yang.
With the patient seated
The head routine was applied with an emphasis on Tui fa, Mo fa and loose fist Pai fa at Du20.
With the patient lying prone
•Tui fa and palm Rou fa along the Governing Vessel from the sacrum to the nape and along the Bladder channel from the nape to the sacrum
•Lifting–grasping along the Governing Vessel from the sacrum to the nape 10 times
•Ca fa along the Governing Vessel and Bladder channel
•I then applied indirect moxa to Du14, BL17, BL19 and BL20 using a moxa stick with bird-pecking technique for about 2 minutes on each point
•Gentle Yin style An fa to the above Back Shu points, directing my attention and Qi down to the Ying Qi level
With the patient supine
•Tui fa and Rou fa along the Stomach, Spleen and Liver channels in the legs
•Indirect moxa on ST36 for 2 minutes
•An fa and Rou fa to stimulate ST36, SP6 and Liv8
On the abdomen
•Tui fa along the Stomach channel
•Palm Rou fa over Ren12, Ren6 and Ren4
•Tai chi Mo fa clockwise
On the face
•The foundation routine for the face working mainly around the forehead, eyes and ears
•Warming palm over her eyes and forehead
•Ji dian fa to Du20 to finish
Advice to the patient
After the first couple of treatments, Izzy came to see me on her own and I was able to talk to her in some depth about food and eating habits in terms of Chinese medicine. She immediately engaged with the concept of Qi and how Qi and Blood were produced from the food that we gave to our bodies. We talked about the extra demands that are put on our Qi and Blood when we engage in sport and how to build up these vital substances with food and regular eating patterns. I stressed the importance of breakfast and suggested that she always kept some fruit and nuts in her bag so that she could eat these throughout the day.
I also suggested that for the next couple of months she eased up with the extra sporting demands during her period.
Progress and subsequent treatments
I treated Izzy weekly for 8 weeks to see what progress we could make over two menstrual cycles. During this time she made a great effort with her diet and eating patterns; she started to eat breakfast, began to eat a lot more fresh fruit and vegetables and took a good packed lunch and plenty of fruit and nuts to school. With the weekly treatments and the changes that she made to her diet, things changed pretty quickly and by the end of the 8 weeks she was looking and feeling much better. There were no more headaches, no fainting and her energy and concentration were much improved. I continued to treat her fortnightly for the next 2 months, and 9 months later, I was giving her treatment occasionally only if she had a very demanding time coming up.
I have treated several cases similar to this and increasingly so over the past 4 years. I have found that teenagers respond very quickly to treatment with Tui na, much in the same way that babies and young children respond to pediatric Tui na.
Migraine
Main complaint
Fiona, aged 40, came for treatment to help with migraines. Her sister had been seeing me for acupuncture and had recommended that she come for treatment. Fiona was scared of needles and did not want acupuncture, but had heard from her sister that it might be possible to treat her migraines with massage instead.
Fiona had suffered with migraines since her early 20s; they had become increasingly worse over the previous 5 years. She had a migraine every month a day or two before her period and also if she was stressed or over-worked. At the time she came to see me, she was having a migraine two or three times a month. They started with a feeling of stiffness in her neck and shoulders the day before. She had visual disturbance in the form of a green zig-zag light, usually in her left eye, and then the headache would come on, which she described as an intense throbbing sensation in her right temple. The headaches were accompanied by nausea and sometimes by vomiting and dizziness. The migraines lasted for 2 or 3 days.
Secondary complaints
Fiona’s menstrual cycle was a regular 27 days. Her periods were very light and lasted for 3 days; she often felt dizzy after her period. She felt tired easily, had dry eyes and often experienced blurred vision. She said she always felt tight and achy in her neck and shoulders.
Palpation and observation
Fiona was generally very tight in her neck, shoulders and upper back. There was a tender knotted area directly over SJ15 on the left, and there was tenderness at GB20 and GB21 and the Huatuojiaji points from T1 to T7.
Tongue
Her tongue was red with lots of red points at the tip and there was no coating.
Pulse
Her pulse was generally Deep, Weak, Thin and slightly Quick, apart from the left middle position in her premenstrual week, which became Wiry.
The diagnosis was Liver-Yang rising with underlying Liver-Yin Xu, and stagnation of Qi in the Tai Yang and Shao Yang channel sinews.
Treatment principle
This was to release and relax the Yang channel sinews in the neck and nape, soothe the Liver, descend rebellious Yang and nourish Liver-Yin.
As Fiona’s migraines always came in the premenstrual phase of her cycle, I concentrated mainly on descending Yang, soothing the Liver and releasing the sinews in the second half of her cycle and focused on nourishing Yin in the postmenstrual week.
Treatment
With the patient seated
•I applied the area routine for the head
With the patient lying prone
•To help to release the Yang channel sinews, clear stagnation and descend Yang I started treatment with gua sha, working down the Governing Vessel from Du16 to Du4, the Bladder channel from BL10 to BL23 and the Gallbladder channel from GB20 to GB21. (In the first three treatments, a lot of red sha came to the surface; as she improved this gradually disappeared)
•Tui fa, Rou fa and pinching–grasping along the Governing Vessel, Bladder and Gallbladder channels in the neck, nape and back
•Kneading–nipping GB20 and Du14
•An fa and Rou fa to stimulate GB21 and SJ15
•Moving Yi zhi chan tui fa either side of the spine to stimulate the Huatuojiaji points from T1 to T7
•Double-handed Gun fa from the shoulders to the waist
•Forearm Rou fa to stimulate BL18 and BL23
•Kneading–grasping to release the muscles above and below the scapula
•Kneading–grasping and kneading–pinching down the Yang channels of the arms, releasing areas of congestion in her forearms as I found them
•Yi zhi chan tui fa to stimulate SJ5 and LI4
•Nian fa to the fingers
•Ca fa to KD1
With the patient supine
•Yi zhi chan tui fa to Liv3
•Mo fa along the Yin channels of the legs
On the chest
•Tui fa from Ren22 to Ren4 and across the chest
•An fa and Rou fa between the intercostal spaces
•Pushing–pressing the supraclavicular fossa
•Tui fa across the ribs
On the abdomen
•Tai chi Mo fa
•Palm Rou fa to Ren4
•Warming palm over Ren4
On the face
•Using the foundation routine for the face as the framework, concentrating on the areas of her forehead, temples, around her eyes and ears
•Warming palm over her eyes and temples
Advice to the patient
I showed Fiona how to apply gua sha to her neck and shoulders and suggested that she did this when she felt the pre-migraine stiffness in her neck coming on. I also showed her the migraine exercise described on page 166. I encouraged her to go back to yoga classes, which she had enjoyed in the past, to help her to relax and to give her some time out from her very busy work schedule.
Progress and subsequent treatments
Fiona responded well to Tui na. She came once a week for a month and then fortnightly for 5 months. By the end of the second month of treatment she was having one migraine a month premenstrually, her energy levels were picking up and she had not experienced any dizziness. She continued to improve and had no further premenstrual migraines from the fourth month of treatment. She found gua sha and the migraine exercise very useful as preventative measures and continues to use these if she feels any signs of a possible migraine. It is now several years since I started to treat Fiona; I still see her once every 2 or 3 months for preventative and maintenance treatment. She has a migraine on average once or twice a year if she has been overdoing things at work.
Hypertension
The patients that I tend to see in clinic with high blood pressure are stressed, middle-aged men and my elderly patients who are often very concerned about their blood pressure. I have found Tui na treatment of great benefit in the management of hypertension in both of these groups of patients.
As we know, hypertension can be caused by stress and is certainly worse for stress, so calming and soothing the Shen and the Qi is of great importance in treatment.
In elderly patients, the root of the problem is usually Deficiency of Kidney-Yin and sometimes both Kidney-Yin and Yang. Deficient Kidney-Yin cannot nourish Liver-Yin and consequently Liver-Yang becomes hyperactive and rebellious. The rebellious Yang can be accompanied by Phlegm and/or Wind.
In stressed, middle-aged patients, the root of the problem is usually a combination of lifestyle factors: too much alcohol and rich food, lack of exercise and rest combined with working too hard and stressful personal circumstances.
Depending on your diagnosis of the underlying disharmony, Tui na treatment usually involves:
•Calming and soothing the Shen, Qi and the Liver
•Descending rebellious Yang Qi
•Cooling and quelling Fire
•Nourishing Yin and supporting Yang
•Tonifying the Kidneys
•Supporting the Spleen and dredging and eliminating Damp and Phlegm
Special technique for lowering the blood pressure
This is a very useful simple technique that I was shown in the Tui na department at the Nanjing second affiliated hospital of traditional Chinese medicine.
Using a little talc as a massage medium, apply Tui fa with your thumbs from SJ17 to ST12 along the sternocleidomastoid muscles, for 5 minutes on each side. Effectively, you are mechanically lowering the blood pressure by pushing along the carotid artery and stimulating the carotid sinus, which sends a reflex response to the brain to lower the blood pressure.
General tips for treating hypertension
•To relax and soothe the patient, start treatment by doing some work on the patient’s head and face using the basis of the foundation routine.
•Release the neck, nape and shoulders and stimulate any relevant points in these areas.
•Apply the special technique for lowering the blood pressure described above.
•Work on the back next; for example, apply gua sha to the Governing Vessel if the pulse is Full and Wiry and the patient has strong symptoms. Stimulate relevant points, channels and areas on the back.
•Work along relevant arm and leg channels and distal points with suitable techniques according to the disharmony.
•For elderly patients with Kidney Xu, apply gentle Yin style Tui na to the lower back, abdomen, channels and points to nourish the Yin. Remember that to nourish with Tui na, you need to work on an area for a relatively long period of time. For example, if you are applying gentle clockwise palm Rou fa to Ren4, you will be applying this for about 5 minutes. In Deficient cases, choose fewer points and areas to treat.
•Work on the chest if Phlegm is part of the problem.
•Work on the abdomen for all cases rooted in Deficiency.
•Finish with gentle work on the face.
•Stimulating GB30 with elbow Ya fa and KD1 with Rou fa is useful for all disharmonies.
To help you plan a Tui na treatment for hypertension, see Table 14.2 for some suggestions of useful techniques to consider including in the treatment of common patterns of disharmony.
Hypertension case study
To help to illustrate the treatment of hypertension with Tui na I have included the following case of a patient I treated in clinic.
Main complaint
David, aged 43, had been told by his GP that his blood pressure was too high. He had discussed with her that he would prefer not to take drugs and would like to try alternative methods first.
He had started working freelance 2 years previously and was constantly worried that work would dry up; this meant he over-compensated by saying yes to everything. This had spiralled out of control over the previous 6 months and he had found himself working 13-hour days on a regular basis. Things were difficult at home as he and his wife both worked from home and they had three young children. David told me that he had become slightly obsessed with taking his own blood pressure; he was taking it every morning and evening and noticed his systolic pressure was quite volatile. When his GP took his pressure, it was 160/85, and when he took his own pressure, the systolic ranged from 140 to 170.
He was very concerned that he was so easily stressed; the slightest thing could make him feel almost panic-stricken.
David’s diet was not great: he was overweight and confessed to having a very sweet tooth, he drank coffee all day long and he ate a lot of dairy products. He used to play rugby but several knee injuries and his increased weight had a put a stop to that so he did not get any exercise. He spent hours in front of his computer and on the phone. David had a red face; he felt hot all the time and disliked hot weather. He said he knew when his pressure was up because he would get a throbbing temporal headache and feel extremely hot and agitated. His head often felt muzzy for a few days after this.
Secondary complaints
David complained of a very stiff neck. He was also bothered by Phlegm in the back of his throat.
Palpation and observation
David’s neck and shoulder muscles were very tight.
Tongue
His tongue was swollen and red, especially at the sides and front, with a greasy yellow coating.
Pulse
His pulse was Quick and Wiry with a Slippery quality on the right.
Diagnosis
The diagnosis was Liver-Fire rebelling upwards with accumulated Phlegm.
Treatment principle
This was to quell the Fire, descend rebellious Yang, cool and soothe the Liver, calm the mind and eliminate Phlegm.
Treatment
With the patient seated
•Tui fa and Mo fa on his head
•Special technique for lowering the blood pressure
Presenting disharmony |
Useful treatment techniques |
Liver-Fire blazing |
Gua sha along the Governing Vessel from Du16 to Du4, the Bladder channel from BL10 to BL23 and the Gallbladder channel from GB20 to GB21 Che fa or pinching–grasping along the Governing Vessel and Bladder channel in the back and along the Shao Yang and Yang Ming channels in the arms and legs and the Yin channels of the arms Tan bo fa along the Bladder channel sinew, stimulating the Back Shu points, focusing on the Liver Back Shu point Elbow Ya fa and Rou fa to GB30 Kneading–nipping, nipping–grasping and strong Yi zhi chan tui fa to stimulate points Face routine to soothe and calm Rou fa to KD1 |
Accumulation of Phlegm |
Head routine with an emphasis on Tui fa and Mo fa Gua sha with your nails over the ST8 area Tui fa and pinching–grasping the back along the Bladder channel Ya fa and Rou fa to stimulate GB30 Pai fa and Ji fa on the back and limbs to disperse Phlegm Dredging the Yang Ming and Tai Yin channels along the arms and legs with Tui fa and kneading–grasping and Nian fa at the fingers and toes to dredge through to the extremities Chest and hypochondrium routine with an emphasis on Ji dian fa and Zhen fa Abdominal routine especially Tui fa, Rou fa, Mo fa and palm Pai fa Coordinated forearm Rou fa over Ren12 and Che fa to stimulate ST40 then Gun fa along the Stomach channel |
|
Deficient Yin and hyperactive rebellious Yang |
Head routine with emphasis on Tui fa and Mo fa Che fa to stimulate GB20 and GB21 Lifting–grasping along the spine from Du14 to the sacrum An fa on BL18 with the intention of descending Qi and soothing Liver Ya fa and Rou fa to stimulate GB30 Figure-of-eight Tui fa, Mo fa and palm Rou fa over the Kidney area Gentle Yin style point stimulation such as holding and joining points like BL23 and KD3 Pushing–pressing BL40 The basics of the chest and hypochondrium routine with an emphasis on Tui fa, Rou fa, Mo fa and pushing–pressing the supraclavicular fossa An fa on ST12 with the intention of descending Qi Tui fa or gentle Rou fa to stimulate KD1 Face routine to finish |
|
Kidney-Yin and Yang Xu |
The basics of the head, neck and nape routines Tui fa, Rou fa and Na fa along the Bladder channel from the nape to the toe Coordinated technique Gun fa and forearm Rou fa, concentrating on the lower back around the Kidney Back Shu points Figure-of-eight Tui fa and Mo fa over BL23 and BL52 Ca fa over BL23 and BL52 Tui fa, Mo fa, Rou fa and Ca fa along the Kidney channels of the legs Tui fa or gentle Rou fa to stimulate KD1 Forearm or palm Rou fa to Ren4 and Ren8 Mo fa and Tui fa over the lower ribs Tai chi Mo fa on the abdomen Warming palm over the Kidneys, the back of the head and over the eyes |
With the patient lying prone
•Gua sha along the Governing Vessel from Du16 to Du4, the Bladder channel from BL10 to BL23 and the Gallbladder channel from GB20 to GB21
•Nipping–grasping Du14 and pinching–grasping down the Governing Vessel to Du4 three times
•Kneading–nipping GB20 and kneading–pinching the neck along the Bladder and Gallbladder channels
•Tui fa down his back along the Bladder channel from the nape to the sacrum
•Pinching–grasping along the Bladder channel from the nape to the sacrum
•Double-handed Gun fa to release his shoulders and upper back
•Tan bo fa along the Bladder channel from the nape to the waist
•Strong Yi zhi chan tui fa on BL18 and BL20
•Strong Ya fa and Rou fa on GB30 until the point was very hot
•Pai fa and Tui fa down his back, arms and legs to dissipate and dredge Phlegm
•Thumb Rou fa to stimulate KD1
With the patient supine
•Tui fa and pinching–grasping along the Stomach and Spleen channels in his legs
•Yi zhi chan tui fa to stimulate ST36, and single-finger Ji dian fa to stimulate ST40
•Yi zhi chan tui fa to stimulate Liv2 and thumb Rou fa to stimulate SP6
•Pai fa along the Yin and Yang channels of the legs
•Tui fa and pinching–grasping along the Yin and Yang channels of the arms
•The basics of the face routine plus Gua fa to stimulate ST8
•Kneading and grasping the sternocleidomastoid
•Pushing–pressing the supraclavicular fossa
•Tui fa, Rou fa and Ji dian fa on the chest
•Tui fa and Mo fa on the ribs and abdomen
To finish
•Holding KD1
Advice to the patient
We discussed diet and exercise at some length. I knew it was essential not to stress him out further by giving him too much to do or by suggesting things that it was highly unlikely that he would initially be able to achieve. So, I kept it simple and suggested he take a half hour walk each day to begin to build up his fitness levels and get away from his computer and phone. I suggested he drank more water by replacing half his cups of coffee with glasses of water and asked him to cut down his dairy and sugar intake and to increase his intake of fish, fruit and vegetables. I also suggested that he stopped taking his own blood pressure for the time being and that he wait for a period of 3 months when he was due to see his GP again for a check-up.
Progress and subsequent treatments
David was very committed to his weekly Tui na treatments; he came once a week for 3 months and over this time he made some very important changes to his daily routine. He really took to his walks, which he increased to an hour a day after lunch. He found they relaxed him and helped him to think more clearly. He made several changes to his diet including reducing coffee to one cup in the morning, cutting out cheese and strictly limiting his sugar intake. He also made the decision to rent an office rather than continuing to work from home; this made it easier for him to regulate his working hours and significantly took the pressure off at home.
After 6 weeks I noticed a marked change in his pulses; they were slower and less Full and Wiry. By this stage he was feeling a whole lot better in himself, he was able to deal with things more calmly and he generally felt more relaxed. At the end of the 3-month period, when he went back to see his GP, his blood pressure was 137/82 and he was having no more hypertensive symptoms.
David now sees me once every few months in general and more frequently if he feels he needs to.