Tui Na is divided into two main categories. The first is active massage, also known as self-massage, a self-administered healthcare method. The second is passive massage, performed by professional therapists on patients for medical treatment, which refers to the clinical massage therapy discussed in this article.
There are numerous massage manipulations in practice, and eight fundamental techniques are most commonly used: pressing, stroking, pushing, grasping, kneading, pinching, vibrating and tapping. These techniques are rarely used alone; in most cases, several methods are combined for better effects.
1. Pressing (An Fa)
Pressing means rhythmically pushing down and releasing on targeted body parts with fingertips or palms. It includes single-hand pressing and double-hand pressing.
Clinically, single-hand or double-hand pressing is applied to the hypochondrium and abdomen. For the back and bulky muscle areas, single-hand weighted pressing is adopted: place one hand underneath, and apply gentle pressure with the other hand on top. Either hand can be placed on the bottom.
2. Stroking (Mo Fa)
Stroking refers to gentle gliding over the skin with fingers or palms. It is often combined with pressing and pushing. Single-hand stroking is widely used on the upper limbs and shoulders, while double-hand stroking is suitable for the chest.
3. Pushing (Tui Fa)
Pushing is to exert force and move hands forward. Single-hand and double-hand pushing-stroking are the mainstream applications, as pushing and stroking are inseparable in actual operation. This combined technique is frequently used on the large muscle groups of arms and legs.
It can also be applied to fingers. Typically, hold the patient’s wrist with one hand, and push and stroke each finger with the thumb and index finger of the other hand, or use only the thumb for manipulation. Traditional pediatric Tui Na mainly relies on pushing-stroking.
Concentrated double-hand pushing-stroking is a practical variant: align thumbs and index fingers of both hands together and push forward simultaneously.
4. Grasping (Na Fa)
Grasping is to gently lift the skin and superficial muscles of the treated area. Single-hand grasping is commonly used on the legs and bulky muscle regions.
For patients with chest tightness, stuffiness or near-syncope caused by stress or irritability, apply single-hand grasping repeatedly on the upper shoulder area above the clavicle. Perform the movement twice per second for 20 times, take a short break, then repeat another 20 times. This will relieve chest congestion and regulate breathing.
5. Kneading (Rou Fa)
Kneading is to place hands closely on the skin and perform gentle circular motions. It is categorized into single-hand kneading and double-hand kneading. Finger kneading works for small areas such as the temples, and palm kneading is used for the broad back.
Weighted single-hand kneading is applied to the calves: place one palm on the calf, and press down with the other hand on top to increase pressure. Double-hand kneading is also ideal for well-developed calf muscles.
Kneading can dissipate blood stasis, relieve stagnation and promote blood circulation, and works remarkably well for local tender points.
6. Pinching (Nie Fa)
Pinching means lifting the skin and muscles away from the bone surface with fingers.
Pinching is similar to grasping but differs in force application: grasping uses overall hand strength with heavier pressure, while pinching mainly relies on finger strength with milder force. As a basic technique, pinching is often combined with kneading.
The squeezing action of pinching activates skin and tendons, and improves blood and lymph circulation. Light pinching dispels wind-cold and removes blood stasis. Deep pinching relieves pain in muscles, tendons and joint capsules induced by wind, cold and dampness. Common types include single-hand pinching and progressive double-hand pinching.
7. Vibrating (Chan Fa)
Vibrating is a rapid, brief and even shaking manipulation, with an ideal frequency of around 10 vibrations per second (600 times per minute). It is also called tremor manipulation.
- Single-finger vibration: Place the thumb vertically on the tender spot, and drive the thumb to tremble by shaking the entire wrist.
- Double-finger vibration: Put thumb & index finger, or index finger & middle finger on painful areas or the glabella, and generate vibration via wrist movement.
8. Tapping (Da Fa / Kou Ji Fa)
Also known as percussion, tapping is mostly used as a finishing step of massage, and can also be applied independently when needed. The force should be flexible, moderate and well-controlled to bring comfort to patients. It is mainly performed with both hands, with four common styles:
Side Palm Chopping
Stand palms sideways with thumbs upward and little fingers downward, leaving about 1 centimeter between each finger. Fingers close when palms fall and slightly separate when lifted, alternating movements with both hands.
Flat Palm Patting
Place palms flat on muscles and pat rhythmically one after another.
Transverse Fist Percussion
Clench fists with the back of hands upward and thumbs facing each other. Keep fists relaxed with a small gap between fingers and palms, and strike alternately. It is suitable for large muscle groups such as the waist, legs and shoulders.
Vertical Fist Percussion
Clench fists vertically with thumbs on top and little fingers at the bottom, two fists facing each other. Keep fists loose with gaps reserved. This method is primarily used on the back and waist.
All four tapping techniques apply to bulky muscle areas including the nape, shoulders, back, waist, thighs and calves.
Key Rules for Tapping
- Force: Start light, gradually increase moderately, then reduce again; never use excessive strength. Combine firmness and softness.
- Speed: Begin slow (2 strikes per second), then speed up gradually to 6–8 strikes per second.
- Duration: Normally 1 to 3 minutes. Adjust the time appropriately according to individual conditions.
- Application: Can be used after regular massage or interspersed with other manipulations.