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3. àn fǎ (pressing manipulation 按法 )
It is a downward pressing movement with gradually increased force on
the local area or point with the finger or palm, classified into zhǐ àn fǎ (finger-
pressing manipulation 指按法 ) and zháng àn fǎ (palm- pressing manipulation
掌按法) according to operating areas.
Manipulation
(1) zháng àn fǎ (palm- pressing manipulation 掌按法)
Stretch the wrist joint dorsally with five fingers naturally extended. Press
the local area with palm or palm root for a few minutes, the strength should
be exerted downward perpendicularly; after that, release the hands and do
downward pressing movement with gradually increased strength again.
Repeat the manipulation a few times.
(2) zhǐ àn fǎ (finger-pressing manipulation 指按法 )
Press downward perpendicularly by taking the thumb ball and middle
fingertips as operating unit. The movement is similar to that of palm- pressing
manipulation.
Movements
(1) Sink qi in Dantian and breathe naturally, avoid to hold the breath.
(2) Do pressing stably without any pulling; increase the strength
gradually.
Precautions
(1) Keep the pressing on the local area for a few minutes; it is not
advisable to release the hands suddenly, forbidden to have rough and violent
movement.
(2) Press a larger area when palm- pressing manipulation is applied, the
pressure should be slightly stronger with mild and slow stimulation.
(3) Press a smaller area when finger-pressing manipulation is applied, the
stimulation should be gentle and soft.
4. mó fǎ (rubbing Manipulation 摩法 )
Move the wrist joint and forearm in circles clockwise or counterclockwise
to lead rubbing movement of palm or the index fingertip, middle finger and
ring finger tipson the local area and point.
Manipulation
(1) zháng mó fǎ (palm-rubbing manipulation 掌摩法)
Extend palm and fingers naturally and make wrist joint stretched slightly
toward dorsal side. Put the palm on the operated area to exert strength. Relax
the wrist joint and move the forearm actively to lead the wrist joint and hand
moving in circles clockwise or counterclockwise.
(2) zhǐ mó fǎ (finger-rubbing manipulation 指摩法)
Extend and close the index, middle, ring and little fingers together; flex
and suspend the wrist joint slightly; move the forearm actively to lead the
fingers rubbing in circles by the fingertips of fingers exerting strength on the
local area or point.
Essentials of Movements
(1) Relax the shoulder, elbow and wrist joints with the elbow joint
slightly flexed.
(2) Relax wrist joint and extend the palm naturally; slightly flex and
suspend wrist joint with metacarpophalangeal joints slightly bended.
(3) Release the strength naturally with slow and harmonious movements.
The frequency of rubbing is 120~160 times/ m.
Precautions
(1) During the operation, avoid to pull subcutaneous tissues.
(2) The fingers should perform a rubbing movement in circles as the
manipulation requires, not tapping or knocking movement.
Fig. 7–10 huáng fēng rù dòng (Wasps going into honeycomb 黄蜂入洞)
Fig. 7–11 àn xián zǒu cuō mó (Scrubbing and rubbing like pressing string
按弦走搓摩)
3. shuǐ dǐ lāo yuè (Scooping the moon up from the water 水底捞月 )
Manipulation
Keep the child in sitting position or supine position. Hold four fingers of
the child with left hand, drip cold water on nèi láo gōng ( 内 劳 宫 ) with the right
hand. Do pushing and transporting manipulation with the tip of middle finger
which was dipped in water, from the root of little finger to nèi láo gōng ( 内劳宫 ),
via zhǎng xiǎo héng wén ( 掌小横纹 ) and kǎn gōng ( 坎宫 ); blow on the child’s
palm to cool it while doing manipulation.
Action
This manipulation, cold in nature, acts to clear heat, cool blood, calm the
mind and eliminate restlessness, usually used to treat excessive heavy
syndromes manifesting unconsciousness due to high fever, disturbance of
nutrient blood by heat, restlessness and constipation.
Fig. 7–12 shuǐ dǐ lāo yuè (Scooping the moon up from the water 水底捞月)
Fig. 7–15 yùn shuǐ rù tǔh (Transporting water into eart 运水入土)
Section 3 Specific Points of Infants
Specific points of infants imply the points used only for infants (Fig. 7-16,
7-17, 7-18). They have locations like “point”, bust also like “route” and
“facet”. Mostly, these specific points are located on the hands and area below
the elbow. Unlike the points of fourteen channels, these specific points are
plain without theoretic system. To facilitate the study and application, the
times of operation recommended in the book are for infants between 6
months to one year old, as reference in clinical application. There should be
determined according to the age and body constitution of infants and severity
of disease in clinic. As a habit, the left hand of the child is taken as an
operated hand when the specific points on the upper limb are manipulated,
no matter whether a boy or girl. Usually, the operation for infant starts from
the head and face, then upper limbs, chest and abdomen, lumbar area and
back to lower limbs at last. This order can be also determined flexibly
according to the condition of disease and the posture of the infant during the
treatment.
6. rǔ páng (乳旁)
Location
0.2 cun lateral to the breast.
Manipulation
Kneading the point with the tip of middle finger is called kneading rǔ
páng (乳旁) (Fig. 7-24). Repeat the manipulation 100~200 times.
Action
Ease the chest, regulate qi, stop cough and resolve phlegm.
Indication
Stuffiness in the chest, gurgling with sputum, cough and vomiting.
Application
Clinically, the manipulations of rǔ gēn (乳根) and rǔ páng (乳旁) are often
used in combination with the tips of index and middle fingers.
7. rǔ gēn (乳根 )
Location
0.2 cun below the breast.
Manipulation
Kneading the point with the tip of middle finger is called kneading rǔ gēn
(乳根) (Fig. 7-25). Repeat the manipulation 100~200 times.
Action
To ease the chest, regulate qi, stop cough and resolve phlegm.
Indication
Stuffiness in the chest, cough, wheezing and chest pain.
Application
As same as that of rǔ páng (乳旁).
8. xiélèi (胁肋)
Location
Hypochondriac regions from axillary line to ST 25 (tiān shū).
Manipulation
Rubbing the hypochondriac regions with both palms from axillary line to
ST 25 (tiān shū) is called scrubbing and rubbing xiélèi ( 胁 肋 ), also named
scrubbing and rubbing like pressing string (àn xián zǒu cuō mó 按 弦 走 搓 摩 )
(Fig. 7-11). Repeat the manipulation100~200 times.
Action
To normalize qi, resolve phlegm and eliminate chest stuffiness.
Indication
Stuffiness in chest, wheezing with sputum, shortness of breath,
hypochondriac pain, etc.
Application
The point is characterized by opening and descending. It is often used for
infantile food retention and phlegm accumulation, chest stuffiness and
abdominal distension due to adverse qi.
9. fù (腹 )
Location
Abdomen
Manipulation
Pushing along the border of costal arch, or separating-pushing from RN
12 (zhōng wǎn) and the umbilicus to the sides of the abdomen is called
separating-pushing abdomen (fēn tuī fù yīn yang, 分 推 腹 阴 阳 ). Rubbing the
abdomen with the palm or four fingers is called rubbing abdomen (mó fù, 摩
腹). Repeat separating-pushing abdomen for 100~200 times, rubbing abdomen
for 5 minutes.
Action
To strengthen the spleen, normalize the stomach, regulate qi and
promote digestion.
Indication
Diarrhea, abdominal distension and pain, constipation, nausea and
vomiting.
Application
For excessive syndromes like infantile diarrhea, constipation, abdominal
distension and anorexia, rub and knead abdomen clockwise (reducing
method); for deficient syndromes like diarrhea due to spleen deficiency, rub
and knead abdomen counterclockwise (reinforcing method). The
manipulation of rubbing abdomen is often combined with the manipulation
of pinching spine and kneading ST 36 (zú sān lǐ). For vomiting due to
indigestion, the manipulation of separating-pushing abdomen is taken as the
main together with pushing manipulation from héng wén (横纹) to bǎn mèn (板
门 ) and pushing tiān zhù gǔ ( 天柱骨 ). In addition, the point is often used for
healthcare of infant.
Fig. 7-26 Rubbing abdomen (mó fù, 摩腹)
10. qí (脐 )
Location
Umbilicus
Manipulation
Apply rubbing manipulation on the umbilicus with finger or palm is
called rubbing umbilicus (mó qí, 摩脐 ); apply kneading manipulation on the
umbilicus with tip of thumb or middle finger is called kneading umbilicus
(róu qí, 揉脐) (Fig. 7-27). Repeat the kneading manipulation 100~300 times and
rubbing manipulation 5 minutes.
Action
Counterclockwise rubbing and kneading can warm yang, disperse cold,
tonify qi and blood; clockwise operation can benefit digestion, eliminate food
retention and promote bowel movement.
Indication
Abdominal pain, constipation, abdominal distension, food retention and
diarrhea, etc.
Application
Clinically, the manipulation of kneading umbilicus is often used together
with manipulations of rubbing abdomen, pushing (qī jié gǔ 七 节 骨 ) and
kneading guī wěi ( 龟 尾 ) to treat diarrhea. Counterclockwise rubbing and
kneading umbilicus is effective for deficiency and cold syndromes such as
pediatric diarrhea, borborygmus and abdominal pain; clockwise rubbing and
kneading umbilicus is good for excess syndromes such as pediatric
constipation and abdominal distension.
LU qi failing
in dispersing LU qi
ascending Cough due
and purifying to
exogenous
pathogens
Dryness of Consumption
airway, of LU fluid,
dysfunction accumulation
of throat of phlegm
and fluid
Invasion of
dryness
LU yin LU qi
deficiency ascending
Constitutional
weakness + Cough
due to
internal
injury
Deficiency-
cold of SP &
ST failing in
transp. &
transf.
Upward
Retention of attack to LU,
water & fluid dysfunction
condensed of LU in
into phlegm descending
Clinical Manifestations
(1) Cough due to exogenous pathogens
Cough with expectoration of sputum, nasal obstruction, running nose,
aversion to cold, headache, thin tongue coating and floating pulse. Cough due
to wind-cold may manifest clear sputum and nasal discharge, severe chills
without sweating, thin white tongue coating; cough due to wind-heat may
show yellow and thick sputum and nasal discharge, mild cold feeling with
slightly sweating, thirst, sore throat, fever, thin yellow tongue coating,
floating rapid pulse.
(2) Cough due to internal injury
Prolonged cough, lower fever or dry cough with scanty sputum, or cough
with profuse sputum, poor appetite, listlessness, lassitude and emaciation.
Tuina Treatment
Principle of treatment
To disperse lung qi and check cough.
Nursing Care
(1) Have light food during treatment; raw, cold, sour, sweetish, pungent,
spicy food and fishes are forbidden to prevent aggravation of cough.
(2) Have proper rest, drink more water, pay attention to weather change,
avoid exposure to wind and cold.
(3) Improve living environment, keep ventilation in room and away from
bad stimulation from smog and oil gas.
2. Fever
Constitutional
weakness + Attacking
body surface
Wind heat
Defensive yang
inhibited
Improper treatment
for diseases due to
exogenous pathogens Excess-heat
in LU and
ST Fever
Internal injury due to
improper intake of
milk & food
Prolonged
disease Internal heat
Consumption due to yin
consuming of yin fluid
yin deficiency
Tuina Treatment
Principles of treatment
To clear heat
Nursing Care
(1) Keep room ventilated and the environment clean.
(2) Have light diet but nutritious.
(3) Take care of body temperature, have bath with warm water to induce
sweating so as to lower down body temperature.
(4) Drink warm water to supplement source of sweat.
3. Asthma
Weakness
of defensive Latent
qi and the phlegm inside
exterior
Asthmatic
Constitutional breath due
Endogenous SP qi deficiency to qi
pathogenic counter-
factors Flowing
Damp
accumulation LU failing in
generating dispersing &
phlegm descending
stored in LU
Asthmatic
Weakness breath
KI qi in
insufficiency due to
receiving shortage
qi of qi
+
Asthma
Attached by
wind cold
Improper
Exogenous diet Inducing Phlegm qi
pathogenic latent blocking
factors phlegm airway
Contacting
foreign
bodies
Clinical Manifestations
(1) Asthma due to cold
Cough, difficult respiration with wheezing, or even with mouth opened
and shoulders raised, inability to lie down flatly, expectoration of clear and
dilute sputum white in color with foams, aversion to cold, absence of
sweating, pale or bluish complexion, cold limbs, no thirst or thirst with desire
of warm drinking, clear and profuse urine, light red tongue with thin white
coating, soggy rapid or floating slippery pulse, light red finger stria.
Tuina Treatment
Principles of treatment
To open the chest, regulate qi, resolve phlegm and ease asthma.
Commonly used manipulations
Pushing fèi jīng ( 肺经 ), pushing sì héng wén ( 四横纹 ), kneading bǎn mèn
( 板门 ), pressing RN 22 (tiān tū), kneading RN 17 (dàn zhōng), kneading rǔ gēn
(乳根), rǔ páng (乳旁), scrubbing and rubbing like pressing string (àn xián zǒu
cuō mó 按弦走搓摩), kneading BL 13 (fèi shù).
Nursing Care
(1) Patients with constitutional weakness or rickets should be
supplemented with nutrition.
(2) Keep warm to prevent attack of exogenous pathogenic factors.
(3) The mother should have less pungent, spicy, fragrant, roasted and
baked food, greasy and sweetish food to prevent milk being influenced.
(4) Have proper rest during asthma attack. Do outdoor exercises to
strengthen body constitution during remission stage. Change dressing in time
to avoid common cold.
4. Vomiting
pathogenic
factors
(cold, heat)
Abnormal qi Affecting
movement functions of
due to fear SP and ST in
and fright transp. and
transf.
Vomiti
ng
Clinical Manifestations
(1) Vomiting due to cold
Intermittent vomiting after over-eating with vomitus not very foul, pale
complexion, cold limbs, abdominal pain alleviated by warmth and pressing,
loose stools, pale tongue with thin white coating, red finger stria.
Tuina Treatment
Principles of treatment
To normalize stomach and pacify adverse qi.
Nursing Care
(1) Feed baby regularly, don’t leave the baby too hungry or too full, or
don’t give food too cold or too hot.
(2) Severe vomiting may cause apnea and asphyxiation, baby with such
vomiting should be under close observation to prevent gastric content
inhaled, resulting in aspiration pneumonia and other diseases of respiratory
tract.
(3) Recurrent vomiting may lead to dehydration, acidosis and so on.
Integrated treatment with western and Chinese medicine should be
recommended at this moment.
5. Diarrhea
Cold-dampness
Dysfunction of
SP in transp. & Water & food,
Dampness-heat transf. which can’t be
transported and
transformed, go
Internal down to LI
damage due to Damaging
improper intake SP and ST
of milk and
food
Dysfunction of
Weakness transportation
of SP and and
ST transformation
Clinical Manifestations
(1) Diarrhea due to cold-dampness
Loose stools with foams, light in color, no foul smell, profuse clear urine,
nausea, vomiting, chest stuffiness, poor appetite, borborygmus, abdominal
pain, mild fever, chills, cold hands and feet, no thirst, white greasy tongue
coating, soft pulse.
Tuina Treatment
Principles of treatment
To invigorate spleen and drain dampness.
Nursing Care
(1) Take care of dietary hygiene to prevent the disease caused by eating.
(2) Feed baby at fixed time with limited milk and food; it is not advisable
to leave the baby sometimes full or too hungry, sometimes too cold and
sometimes too warm.
(3) Take light food easy for digesting and keep away from greasy food
during the attack of diarrhea.
6. Anorexia
Constitutional
yin deficiency ST is
ST yin deprived of
insufficiency nourishment
Febrile diseases
consuming yin
Anorexi
Congenital
deficiency ST failing in
a
SP and ST receiving
depletion food
Weakness
after illness
Disturbing
Being qi
frightened, movement,
Emotional LV qi
scolded or disorders
abused stagnation
damaging
SP
Clinical Manifestations
(1)Dysfunction of spleen in transportation and transformation
Refusing to take milk or food, or no desire of taking food, tasteless,
lusterless complexion, emaciation, pale tongue with thin white or greasy
coating, soft moderate pulse.
Tuina Treatment
Principles of treatment
To invigorate spleen and promote digestion
Nursing Care
(1) Feed the child in a correct way at fixed time, rectify bad eating habits.
(2) Don’t force the child to eat; it may make the child disgust with eating.
(3) Offer varied food good for digestion according to the age to increase
eating desire and benefit stomach and intestines.
7. Constipation
Obstruction
Accumulation of Fu-
of heat in ST Consuming
body fluid organs
and intestines
Excess
constipation
Constipatio
n
Weak
transportation
of large
Constitutional Intestine
deficiency
Qi
Qi & blood deficiency
insufficiency Deficiency
constipation
Blood
Long time of deficiency
illness diseases
Fluid failing
to moisten
LI
Clinical Manifestations
(1) Excess constipation
Dry stools, difficult defecation, scanty dark urine, red face, warm body,
hypochondriac and abdominal distension, abdominal distending pain,
reduced appetite, dry mouth, restlessness, red tongue with yellow coating,
rapid pulse, purple finger stria.
Tuina Treatment
Principle of treatment
To remove obstruction and promote bowel movement.
Nursing Care
(1) Build up habit of defecation at fixed time.
(2) Take more fruits, vegetables and grain, keep away from spicy,
pungent and high flavored food.
(3) Have proper outdoor exercises.
8. Night Crying
Abdominal
pain
Attacked by
heat before
birth, heat
accumulated
in HT and SP Excessive HT
fire causing Inability of
internal heat falling
& restlessness asleep
Heat moving
upward to
disturb HT
Night
cryin
g
Scattering
mind due to The mind
is out of Alarm
fear and with fear
fright its
residence
Uneasy
Retention of sleep due to
milk & food stomach
distending
pain
Clinical Manifestations
(1) Spleen cold
Pale or bluish complexion, timidity, sleepiness, cold limbs, or
accompanied by diarrhea, curled up during abdominal pain, feeble crying,
preference for pressing his or her belly by hands, pain alleviated by warmth.
Tuina Treatment
Principles of treatment
To calm the mind and ease mood.
Nursing Care
(1) Have proper clothing; keep warm to prevent cold for the baby with
spleen cold; don’t put on too much clothes for the baby with heart heat.
(2) Feed baby at fixed time with limited milk and food; it is not advisable
to let baby sometimes too full sometimes too hungry, sometimes too cold and
sometimes too warm.
(3) Pregnant women and mother in breast feeding should avoid eating
too much cold, pungent, spicy and hot food.
(4) Keep room quiet and avoid scaring the infant.
9. Enuresis
Congenital Deficiency-
deficiency cold of
of kidney qi lower
energizer Failing in
controlling
water
passage
Spleen-lung Sinking of
depletion qi due to
deficiency Enures
is
Heat in KI failing in UB failing
liver storing in storing
Channel essence urine
Clinical Manifestations
Involuntary urination while asleep, especially worse after fatigue or in
cloudy and rainy days; the child with mild condition may have bed-wetting
once a few nights, while the child with severe condition may have bed-
wetting once, twice or more every night, some children even have enuresis at
daytime. The child with enuresis for long time usually manifests sallow
complexion, lower intelligence, lassitude, dizziness, lumbar soreness and cold
limbs. The child of elder age may show coyness or nervousness.
Tuina Treatment
Principles of treatment
To warm kidney and astringe urine.
Nursing Care
(1) Train the child to have urination at fixed time and build up a
methodical life for child to save from tiredness.
(2) In addition to active treatment, necessary nutrition should be
supplemented and proper rest should be arranged. Don’t offer drinks to the
child two hours before sleep and give less liquid food.
(3) While asleep, wake the child at fixed time for urination to build up an
orderly life habit.
(4) Parents should consider the child’s emotional welfare, try to diminish
their nervousness.
10.Infantile Myogenic Torticollis
(3) And also, it is thought intrauterine deflexion of fetus’ head to one side
affects blood supply of sternocleidomastoid muscle of one side, causing
ischemia of the muscle. This condition has no relation with delivery process.
Clinical Manifestation
(1) After birth, a spindle-shaped mass could be found on one side of the
neck, the sternocleidomastoid muscle of affected side gradually gets
contracted and tensed, and the prominence is cord-like.
(2) The infant’s head bends toward affected side and the face toward
healthy side.
(3) A few infants only show hard mass like warts around attachment
point of sternocleidomastoid muscle at clavicle of affected side.
(4) Prolonged condition may influence the development of face at
affected side; the healthy side of the face will have adaptive change, making
the face asymmetric. At later stage, the disease would be accompanied by
compensatory thoracic scoliosis.
Tuina Treatment
Principles of treatment
To relax sinew, dredge collaterals, soften hard mass and eliminate
hemotoma. The treatment is mainly done on a local area.
Nursing Care
(1) Parents may often pull affected sternocleidomastoid muscle to extend
the muscle.
(2) To correct the pathological posture by adopting certain movements to
opposite direction, such as feeding, sleeping on particular pillow, or attracting
the infant’s attention with toys.
(3) Parents may have home-massage for the infant by taking kneading
manipulation with fingertips of index, middle and ring fingers on infant’s
neck of affected side, and kneading local nodule.
11. Infantile Subluxation of Radius Head
Clinical Manifestations
The disease often occurs in infants with affected limb once injured by
pulling, manifesting elbow pain with semiflexion of elbow joint and
pronation of forearm, tenderness on the area of capitulum radii and absence
of obvious swelling or malformation on local area. The child stops using the
arm to take things and other elbow movements, and dislikes being touched.
The locations of lateral epicondyle, medial epicondyle of humerus and
olecranon are normal. X-ray examination can’t show the lesion.
Tuina Treatment
Principles of treatment
To relax sinew for reposition and stop pain.
Method
It is not necessary to have any anaesthesia. Face the child when the
parent holds the infant. The condition that the right side is affected is taken as
an example.
(1) Place left thumb on lateral side of radius head and hold the upper part
of wrist with right hand, stretch and rotate forearm backward.
(2) Then, flex affected elbow joint, the radius head would be returned to
it’s normal position.
Nursing Care
(1) After reposition, elbow pain may disappear immediately, the infant
stops crying and can flex the elbow, raise the arm to take things normally.
(2) Generally, it is not necessary to have external treatment if there is no
obvious swelling. Neck wrist sling can be used to append the elbow in flexed
position 2-3 days.
(3) Don’t pull the affected limb during dressing or undressing in case of
second injury and causing habitual dislocation.
(4) Don’t walk hand by hand with the child, because the adult is much
taller than the child, it is liable to have subluxation of radius head when
forearm of child is pulled in raising up position.