Journal of Chinese Medicine • Number 93 • June 201022 Tuina: East and West

Tuina: East and WestBy: Zarig

Cooper

Keywords: Tuina, qigong,

tai chi, yin-style, yang-style, yi zhi chan tui fa,

gun fa

AbstractTuina is a therapy that is growing in the West and which has great potential for further expansion and acceptance. In the UK, however, it is often practised and taught quite differently from in modern China, which has resulted in varying standards of practice and major divisions in style and approach – indeed, tuina in the UK seems to have changed significantly in transit. This situation may be replicated in other countries, and there is a risk that the quality of tuina in the West is becoming diluted due to students qualifying with widely variable skills and inaccurate views regarding the nature of authentic tuina. This article contrasts the training and practice of tuina in China and the UK and discusses what can be learnt from its inseparable links with qigong and tai chi.

During my first internship at the Zhejiang Hospital of Traditional Chinese Medicine I experienced a variety of emotions - ranging

from inferiority to awe. Doctors in the teaching hospitals in China often encourage students to practise alongside them as they work, and it is from this close contact with skilled practitioners that I was confronted with the actual level of my skill. Even as a tuina practitioner with some experience, I found that I was not able to perform even the simplest techniques with anywhere near the indifferent proficiency and skill that I witnessed. Despite my beliefs to the contrary, I found that I was not flexible, relaxed or focused enough to sustain treatment with comparable strength or depth. I was simply not physically able to move my wrists, hands and arms in the correct way. I was surprised that I had not been exposed to such a high standard of tuina before, where so much power and qi is transmitted during treatment. It was only through return study trips to China, a steely determination to practice what I had been taught, and diligent practice of qigong that I began to sense what is required to become an effective practitioner of tuina.

Throughout the history of tuina various schools have emerged that have focused on particular areas of practice. Depending on where one travels in China today one might experience different types of tuina treatment. In Shanghai and its surrounding area, for example, gun fa (rolling technique) and yi zhi chan tui fa (one finger meditation technique) are used extensively, and make up the majority of the treatment; in the Beijing area, deep pressing techniques using the elbow are preferred and a different style of yi zhi chan tui fa is used; further north, gun fa is rarely used (other than in a relaxing capacity) and yi zhi chan tui fa again takes a slightly different form. Although different in approach, these styles are all united by the

common theories that underpin all effective styles of tuina and which are discussed in this article.

The development of tuina in the West (and particularly in the UK) has taken a different path, however; it is common in the UK to see tuina described as ‘yin-style tuina’, ‘qigong tuina’ or ‘yang-style tuina’. Such is the growing disparity between these styles that they can cease to resemble each other at all. If you were to ask a yin-style practitioner about yang-style, the response might frequently be that yang-style is brutish and aggressive and relies on muscular strength without subtlety. If you asked a yang-style practitioner about yin-style you might get the view that it is a placid, esoteric, delusional - and consequently ineffectual - method of practice.

This article discusses these common misconceptions and explores how such polarised approaches have arisen. The common themes and philosophies that unite authentic tuina with tai chi and qigong are also explored, as well as how tuina is taught and practised in modern China.

The yin and yang of tuinaOne of the most basic principles of traditional Chinese medicine is that yin and yang are inseparable. This was the answer I received when I asked tuina doctors in China about the yin and yang styles of tuina in the UK. Most simply did not understand the question, while others offered the (apparently unnecessary) explanation that it was not possible to separate the two: ‘There is no yin or yang tuina, there is only tuina … different techniques and approaches are used that are appropriate to the patient and the disease’, was the answer I received. Taking a different tack, I asked, ‘What about the use of qigong in tuina, isn’t that a different style?’ Again, after the initial looks of exasperation and bewilderment came the response, ‘Tuina is qigong!’.

Journal of Chinese Medicine • Number 93 • June 2010 23Tuina: East and West

One of the first things one notices when observing a tuina practitioner in China is the relaxed, almost nonchalant, manner in which treatment is delivered. The body appears to hold no tension, the arms move without hesitation and the muscles and sinews seem to work with effortless ease. To the trained eye and to the patient, however, there is clearly far more going on beneath the surface. In authentic tuina an exquisite level of pressure is delivered to the body that many people will not have experienced; a tuina doctor can deliver great strength and power through an apparently soft, relaxed body. Where does this power come from? Is it muscular strength or is it qi? Is it good technique or is it intention? How can we understand these different concepts, and what is meant by the statement ‘Tuina is qigong’?

Full and empty tuina The process of developing one’s mind, intention and qi goes hand in hand with the development of physical strength and power. Without a relaxed and focused mind and intention one cannot practise tuina. Equally, without strong muscles, tendons, correct posture and a well-developed technique, effective practice is impossible.

The same principles that apply in tuina also apply in tai chi. A tai chi movement performed correctly is relaxed and soft, yet contains great strength and power. I am often asked by my teachers during tai chi training whether I am using li or qi in my movements (li in the context of tai chi and tuina means ‘using muscular strength’). At the beginning of their training, a tai chi student has no choice but to use li in order to hold a posture or make a movement, because no other way is known. Through correct training and skilled guidance, however, the foundations of relaxation, a strong body and good technique are built, and li is gradually replaced with qi.

There is a huge difference between the two concepts – hardness, tension and short-lived strength come from using li, whilst softness, relaxation and lasting power come from using qi. Tai chi and qigong training develop the ability to work your body and mind very hard and yet remain soft and without tension. Why is it not possible to do this immediately? The answer to this question is not that beginners do not have any qi, but rather because they have no concept of how to skilfully develop and apply their qi, and are unable move their bodies in the correct way.

During the practice of tai chi this process of filling one’s technique with qi and intention and emptying it of li and tension is known as developing ‘peng’ (pronounced ‘pung’ and translated as ‘a soft yet deeply powerful structure and form’). Peng can be experienced if one touches a tai chi practitioner,

but is not something that can be easily described or understood merely intellectually. As with traditional tuina training, peng is best learnt through skilled guidance and practice.

A tuina student in China trains for 18 months just practising a few techniques (usually gun fa and yi zhi chan tui fa, as they are two of the hardest to master). When a student at this level applies a technique - just like a beginner in tai chi - they are only capable of using hard muscular strength. This is the natural way to begin. Through continuous practice of correct posture and movement, however, the joints and muscles are simultaneously strengthened and coaxed into a state of relaxation. A framework is created that is strong and soft, powerful yet relaxed. This, however, is just the beginning.

It is only after this framework has been built that the process of developing the use of intention, mind and qi can be set in motion. Over the next three to four years, a tuina doctor progresses through specific levels of attainment until senior therapist level is reached. Such ongoing physical work, combined with a training program of qigong, produces a practitioner who has a developed body and mind and understands how to empty their movements of tension and fill them with qi. Such a practitioner is able to deliver very strong treatments because they can combine strength with intention, but is also sensitive and skilled enough to treat newborn babies or very deficient patients.

It can therefore be seen that qi, the mind and intention are being developed throughout tuina training. ‘Qigong tuina’ as a term does not exist in Chinese hospitals. When I asked senior doctors about qigong healing, I was told that it is viewed as one of the highest forms of healing, that takes many years of physical training and regular practice of both hard and soft qigong and meditation to attain, and is the reserve of only the most skilled and dedicated practitioners. The head of the tuina department, Dr Li, told me that attempting to influence the qi of a patient without understanding and being fully in control of your own qi is at best ineffective and harmless, but otherwise can harm both the patient and practitioner. The belief that a yin-style tuina practitioner can apply qi and use their mind and intention without first developing their body and technique through proper practice is therefore erroneous and, practically speaking, is like skipping the first years of training. Conversely, a yang-style practitioner who uses muscular strength

Generally in the West there seems to be less time allocated to developing key foundation skills compared to China...

Journal of Chinese Medicine • Number 93 • June 201024 Tuina: East and West

without softness, relaxation and development of their mind and qi is equally mistaken. Lieh Tzu describes such a learning process as follows:

‘Agility of body and stillness of mind are required for intention to be communicated naturally. A stiff body whose parts do not cooperate cannot respond to intention no matter how clear and still the mind is. Likewise, an agile body will only meet with confusion if the mind is not still. Therefore, to attain the highest level of any skill both body and mind must be trained simultaneously.’ (Wong, 2001)

Put simply, yin without yang or yang without yin can only produce empty tuina. Unfortunately empty tuina is encountered frequently in the West.

Tuina in the UKA tuina student in the UK will usually train for one year alongside an acupuncture course and from the very beginning will be exposed to an artificial division of yin and yang styles. Compared to China, most students and practitioners in the UK do not practice the physical techniques for long enough or develop the required stillness of mind to provide effective treatment. They may also go through their entire training and working lives without understanding the difference between li and qi, or what it means to ‘fill one’s movements with qi’.

There are some very good practitioners in the UK who have trained long and hard, but an increasing

number of graduates do not grasp the basic skills that are among the first to be learnt in China; there are very few - if any - tuina courses in the UK that devote enough time developing these skills. Some courses only take a few weekends to achieve certification, whilst others do not include clinical training, or else gloss over the hard work needed to master the necessary techniques.

Generally in the West there seems to be less time allocated to developing key foundation skills compared to China, and this can make it difficult to develop the strength and flexibility required to use the basic techniques properly before formal training is finished. Consequently, Western tuina students and practitioners have no choice but to look for further understanding and skill from other areas. Practitioners and teachers draw on other therapies such as physiotherapy or osteopathy, or turn to other less physically demanding Eastern healing systems such as shiatsu or reiki, because they are not aware of how to apply basic techniques with the requisite skill.

Where to go from here?This article is based on the author’s ongoing experience of tuina in the UK and China. It is intended to inform and promote debate concerning current divisions in the UK and the need for authentic training in tuina at postgraduate level. The UK register of Tuina Chinese Massage (UKRTCM) has recently formed, which aims to represent practitioners and promote a recognised

Fig 1: (Left)The outpatient

tuina ward at Zhejiang Hospital of Traditional

Chinese Medicine

Fig 2: (Right) Dr Ye applying his powerful yi

zhi chan tui fa with typical

nonchalance

Journal of Chinese Medicine • Number 93 • June 2010 25Tuina: East and West

standard of tuina to the public. This is a welcome step and sorely needed, although the challenges still facing the progression of tuina in the UK have not diminished.

The recent evolution of tuina, in which key foundation skills are not properly taught, threatens to dilute and distort tuina medical massage out of all recognition from its source. Tuina has inevitably changed as a result of its transportation to the West. The current division between yin and yang styles need not be so polarised, however, as there are common themes that unite all authentic tuina. Many massage and healing modalities are practised in the West that aim to relax the patient and ‘balance energy centres and meridians’. Tuina is not one of these, however; rather it is a medical treatment that has to be administered in a specific manner in order to be effective.

Dedicated qigong courses for tuina practitioners are sorely needed, so that practitioners truly understand ‘energy centres and meridians’ (and have any hope of balancing them). Any qigong or tai chi practised regularly can be beneficial in this regard, although there are specific systems that are particularly useful in tuina training. The yi jin jing sets (muscle and tendon changing exercises) and shaolin neigong exercises (shaolin internal exercises) have wide-ranging effects if practiced every day. Such practices specifically strengthen the muscles, bones and tendons, develop qi and focus, and can dramatically change the body and mind for the better if practised regularly. They

can, however, only be learnt from a skilled teacher. Ultimately, of course, it would be best to spend time in China and experience tuina treatment in its native environment so that the differences detailed here can be felt first-hand.

Zarig Cooper qualified in tuina and acupuncture at the London College of Traditional Acupuncture and is a student at the Mei Quan Academy of Tai Chi. He has received further training in London and China and obtained certificates of clinical internship from the Zhejiang Hospital of TCM in Hangzhou. Zarig practises privately in London and runs a low-cost teaching clinic that specialises in providing ongoing dedicated tuina training modelled on clinics in China. For more information go to zarigcooper.com.

AcknowledgementsThe author would like to thank Brett Robertson of the Mei Quan Academy of Tai Chi and Dr. Li, Dr. Ye and Dr. Jiang at the Zhejiang Hospital of TCM. The UKRTCM can be found at www.ukrtcm.org

ReferencesWong, E. (2001). Lieh Tzu: A Taoist Guide to Practical Living. Boston

& London: Shambhala. pp 155.

Fig 3: Dr Jiang stretching an elderly patient at the end of a session