Tendon-Regulating Manipulation: Warming, Regulating, and Moving Techniques

Muscle-regulating manipulation techniques have the effects of dredging meridians and collaterals, promoting blood circulation to remove blood stasis, and moving qi to helps with occasional pain. They are mainly used for acute soft tissue injuries in various parts of the body caused by various reasons, blood stasis, swelling, and pain caused by chronic strain, or meridian blockage, blood stasis, swelling, and muscle pain caused by external pathogenic factors such as wind, cold, and dampness. Muscle-regulating manipulation techniques are divided into three types: warming techniques, regulating techniques, and moving techniques.

1.Warming Method: External pathogens such as wind, cold, and dampness invade the human body, obstructing the flow of qi, causing incomplete opening and closing of sweat pores, and blocking the meridians. The warming method can open blockages, dredge the meridians, open the sweat pores, dilate blood vessels, and promote blood flow to achieve the goal of supports wellness. The warming method can be divided into four types:

Use the palm or fist to perform rubbing manipulation on the body surface to improve skin temperature and dilate capillaries; or use the pressing-with-warm-palms method, that is, rub the palms together to generate heat and then press them onto the Mingmen acupoint (GV4) at the waist and the epigastrium and abdomen. This is used to supports Kidney-yang deficiency with cold syndrome or Spleen-yang deficiency syndromes such as cold pain in the epigastrium and abdomen and dawn diarrhea, achieving the goal of dispelling cold and relieving pain.

Far-infrared therapy devices, TDP therapy devices, ultraviolet therapy lamps, and moxa sticks are used to apply heat to the surface of the human body to improve skin temperature and subcutaneous tissue temperature, promote vasodilation, increase blood flow, thereby achieving the goals of promoting blood circulation to remove blood stasis, dispelling cold, and relieving pain.

Methods such as traditional Chinese medicine fumigation and steaming, medicinal fumigation and washing, sauna bath, hot water bath, and hot compress are employed to stimulate the vigorous secretion of sweat glands, ensure the normal opening of sweat pores, dilate blood vessels with stasis, and dredge meridians, thereby achieving the goals of dispelling cold and dampness, and relieving pain by removing blood stasis.

Take warm-natured herbs internally. Warm-natured traditional Chinese herbs generally have pungent and warm or extremely pungent and hot properties and flavors, and possess the functions of warming meridians to unblock collaterals and dispersing cold to helps with occasional pain. Therefore, taking warm-natured herbs internally can achieve the goals of dispelling wind, dispersing cold, eliminating dampness, and relieving pain. The above warming method is a specific manifestation of the supports principle of “supports cold with heat” in traditional Chinese medicine theory.

2. Principle and Method The term “Li” (理) means to dredge, unblock, and ensure smooth flow. As the saying goes, “Obstruction leads to pain,” which sufficiently illustrates the importance of “unobstruction.” The principle and method is an extremely crucial technique in tendon-regulating manipulation, being a comprehensive approach that integrates pushing, grasping, kneading, pressing, and plucking techniques. Its primary function is to dredge the meridian pathways, enabling unimpeded blood flow to achieve therapeutic purposes.

Pushing method refers to a technique where fingers, palms, or other parts of the hand are used to perform unidirectional linear or arc-shaped pushing movements on a specific area or acupoint of the body surface. There are numerous terms for the pushing method, which can be classified based on the part of the hand used: palm pushing, finger pushing, heel of palm pushing, thenar eminence pushing, fingertip pushing, pulp of finger pushing, thumb pushing, single-finger pushing, multi-finger pushing, dorsal hand pushing, dorsal interphalangeal joint pushing, forearm pushing, or elbow joint pushing. Based on the form of the technique, it can be classified as flat pushing, straight pushing, circular pushing, separating pushing, joining pushing, and planing pushing.

Flat pushing: It is a type of pushing technique with relatively strong force. Flat pushing is mainly applied to the chest and abdomen, shoulders and back, waist and buttocks, as well as the limbs, and is used to supports soft tissue wellness such as rheumatism and bi-syndrome, and meridian spasms.

Separating pushing: Place the pulp surfaces of both thumbs on the same part of the body surface or acupoint, and then move them in opposite directions to separate them towards both sides. Therefore, it is also called the separating method. The separating method can be used on the back and waist to expel wind and unblock the meridians; on the chest and rib area to regulate qi and dilate the chest; on the epigastrium and abdomen to promote digestion and eliminate food stagnation; and on the transverse wrist crease to balance yin and yang.

Pao Tui (a kind of massage technique): Using one or both hands to hold the affected limb and perform a pinching, grasping, and pushing movement upwards or downwards is called Fenxing Pao Tui. It has the effect of dredging the meridians and unblocking the collaterals.

Na Fa (Lifting and Squeezing Manipulation): This technique involves using the thumb, index, and middle fingers to grasp and gradually apply inward pressure on a specific area or acupoint. Na Fa can be categorized into three types: three-finger Na Fa, four-finger Na Fa, and five-finger Na Fa. This manipulation has a strong stimulating effect and is commonly applied to the neck, shoulders, and limbs. For example, applying Na Fa to Fengchi (GB20) can induce sweating and release the exterior; applying it to Jianjing (GB21) can regulate qi and blood throughout the body; applying it to Hegu (LI4) can helps with occasional toothache; applying it to Chengshan (BL57) can supports muscle cramps; and applying it to Dujiao (an extra point) can helps with occasional abdominal pain. Additionally, the “Back Grasping, Twisting, and Pulling Manipulation,” which is similar to Na Fa, has the effects of dispersing wind, releasing the exterior, and dredging the meridians. It is used to supports exterior excess syndrome of wind-cold cold.

③ Kneading method: Using the fingers, palm, heel of the palm, forearm, or elbow of the hand to adhere to a specific part or acupoint, and making gentle and slow circular (circumferential) rotations to move the subcutaneous tissues is called the kneading method. The kneading method is a gentle technique. It is similar to the rubbing method, but the difference lies in that:

Kneading method: It involves fixing on a certain part or acupoint, applying a slight amount of force to perform a deeper kneading action, and driving the subcutaneous tissue of that part without sliding on the skin.

Rubbing manipulation: Apply relatively light force and perform a rotating stroking motion on the surface area being rubbed, without moving the subcutaneous tissue of that area.

Kneading manipulation can balance yin and yang, regulate qi and blood, mobilize muscles, dissipate blood stasis and disperse nodules, unblock meridians and helps with occasional pain, promote blood circulation in deeper tissues, enhance gastrointestinal digestion and absorption, and facilitate the elimination of metabolic products and toxic substances. Rubbing manipulation can regulate qi and harmonize the middle-jiao, promote digestion and remove food stagnation, and regulate gastrointestinal motility.

④ Pressing method: It is generally similar to the An method (pressing with the finger, palm, or elbow). Both involve using the fingers, palm, or elbow to apply pressure from the surface to the deeper tissues on the patient’s skin. However, there are fundamental differences between pressing and An method. For example, the An method stimulates a broader area with relatively lighter and quicker pressure, while the pressing method applies heavier pressure, has a stronger stimulating effect, and targets a narrower area. The pressing method can be divided into three types: finger pressing, palm pressing, and elbow pressing.

Although the contact area of finger pressure is small, the stimulation intensity is relatively strong, thus it has a more obvious effect of opening blockages and dispersing cold to helps with occasional pain.

When applying palm pressure, due to the relatively large contact area and the gentle stimulating force, it can be used to dredge meridians, warm the middle-jiao and disperse cold, and harmonize meridians to helps with occasional pain.

The pressure applied by elbow pressing is particularly strong, with an exceptionally intense stimulating force. It is commonly used on thick and firm muscle areas such as the waist, buttocks, and limbs.

In addition, the point-pressing method, which is similar to the pressing method, is characterized by concentrating the applied force on a small point, primarily used for pressing acupoints or narrow bone crevices.

⑤ Plucking manipulation: Press the single or double thumbs on subcutaneous nodules or cord-like hard masses (muscle bundles or tendon knots), and repeatedly pluck in a perpendicular direction. This can make swollen muscle bundles become soft and disperse hard tendon knots. Plucking manipulation has the effects of softening hard masses and dispersing nodules, dredging meridians and promoting the flow of qi and blood, relieving spasm and alleviating pain, and separating adhesions. It is one of the important techniques in tendon-regulating manipulations.

⑥ Smoothing manipulation: Using one or both hands to grasp the limb, alternately loosening and tightening, and moving along the limb from top to bottom in a repeated manner. This is called smoothing manipulation, also known as tendon-smoothing manipulation. It has the functions of smoothing the meridians and relieving pain.

⑦ Rubbing Manipulation: This technique involves using the palmar surfaces of both hands to grip a specific part of a limb, applying relative force, and rapidly rubbing up and down in opposite directions. It is commonly applied to the limbs and costal regions. Its functions include dredging meridians and collaterals, promoting qi circulation and blood flow, and relaxing muscles.

3.In addition, there are many compound manipulation techniques in practical operation, as exemplified below:

Rubbing and pushing method refers to using the thumb(s) of one or both hands or the posterior part of the elbow joint to first rub 1 – 3 times on the upper back or the proximal end of the affected limb of the patient, and then push downward in a straight “one” line once. Repeating the process of pushing and rubbing from top to bottom multiple times is called the rubbing and pushing method. It is one of the extremely common and important techniques among the muscle-regulating manipulations. This method is mainly applicable to the neck, shoulder and back, waist and buttocks, and the limbs, and has the effects of dredging meridians and collaterals, dissipating blood stasis and resolving masses, and promoting qi circulation to helps with occasional pain.

② Na-rou Manipulation: The so-called “Na-rou” involves using one or both hands to grasp a specific part or acupoint firmly, first applying the grasping technique, and then adding a rubbing motion based on the grasping. This method is suitable for the neck, shoulders, and limbs, and has the effects of dredging meridians, promoting blood circulation, moving qi, and relieving pain. It is also one of the important and commonly used techniques in tendon-regulating manipulations.

③ Bobo-rouing manipulation: This involves placing the thumb of one or both hands perpendicular to the direction of muscle or muscle fascicle swelling or tendon nodules and performing a deep and forceful bobbing and rouing motion. Known as the bobo-rouing manipulation, it is one of the extremely common and important techniques in the category of tendon-regulating manipulations. It is primarily applied to the neck, shoulders, back, waist, buttocks, and limbs, and has the effects of relaxing tendons and dredging meridians, softening hardness and dispersing nodules, and eliminating blood stasis and relieving pain.

(3) Moving Technique The moving technique is also a type of muscle and tendon manipulation technique, encompassing three aspects: active movement, passive movement, and resistive movement.

Self-exercise refers to instructing patients in the necessary movement techniques, enabling them to perform exercises as directed by the massage therapist to achieve the goals of dredging meridians, dispersing blood stasis, alleviating pain, and promoting wellness recovery.

Passive movement refers to the massage therapist consciously helping the patient move to achieve the goal of promoting circulation and relieving pain.

Anti-movement technique refers to the simultaneous application of opposing forceful movements by the masseur and the patient on a specific limb of the patient, aiming to regulate the meridians and restore displaced tendons or ligaments to their proper positions.