TCM Acupuncture and Massage

Chapter 27 Health massage techniques for middle-aged and elderly people (2)
[-]. Dredge the meridians, promote qi and blood circulation, remove blood stasis and relieve pain
The manipulation acts on the body surface to cause local meridian reactions, stimulate and adjust the meridian qi, affect the connected viscera and limbs through the meridian system, and regulate the physiological and pathological conditions of the body, so that all channels will be dredged, the five viscera will be peaceful, and the body will be in harmony. The human body resumes its normal functional activities. The so-called "where the meridians go, where the indications go" clarifies this truth.

[-]. Relieving tendons and dispersing knots, repairing wrong seams, smoothing and sharpening joints

The activities of muscles, bones and joints can cause a series of pathological changes due to direct or indirect injuries of patients, or long-term strains and many other internal and external factors, including local sprains, fiber ruptures, tendon avulsions, joint dislocations and other diseases.After the manipulation, it can promote the circulation of local qi and blood, reduce swelling and dissipate stagnation, and improve metabolism. Appropriate passive exercise can help loosen adhesions, smooth joints, correct tendons and joints, and restore the normal physiology of the human body. Features.

[-]. Adjust the function of viscera and increase the ability of disease prevention and resistance
The manipulation acts on the body surface of the human body, conducts through the meridians, and has a two-way regulating effect on the functions of the viscera and fu organs.It has been reported that manual therapy for infirm and allergic patients can prevent or reduce the occurrence of colds; some cardiovascular patients often use manual therapy or self-massage, which can prevent the occurrence of cardiovascular and cerebrovascular accidents; in addition, a large amount of data shows that , the effect of manipulation on the prevention and treatment of geriatric diseases is being paid more and more attention, especially in the aspects of degenerative diseases, functional diseases, disease rehabilitation and health preservation and anti-aging of the elderly, manipulation has an irreplaceable role.

In short, through the functions of dredging the meridians, promoting qi and blood circulation, dispelling blood stasis and relieving pain, regulating tendons and dispersing stagnation, adjusting bone joints, smoothing joints, adjusting viscera and increasing the ability to prevent and resist diseases, the human body can finally achieve the harmony of yin and yang.

Basic techniques of health care massage for middle-aged and elderly people
[-]. Method classification

Tuina manipulations are famous all over the world for their long history, numerous schools, rich manipulations, strong skills, wide indications and remarkable curative effect.According to the current statistics, there are more than 400 kinds of techniques that have been found in writing, and there may be more techniques that have not been finalized among the people.In fact, due to the different genres in clinical application, there are only more than 100 commonly used techniques. There are certain rules in the application of these techniques. The clinical summary is nothing more than:
1. Vertical force, such as pressing, pressing, pointing, pinching, etc., all apply different forces from top to bottom.

2. Plane force, such as rubbing, rubbing, horizontal pushing, direct pushing, rotating pushing, wiping, etc., is all about exerting force on the body surface up and down, left and right, front and back or circling back and forth.However, there is also downward pressure when applying force on a plane, but there is an obvious focus when performing the operation.

3. Symmetrical force, such as holding, pinching, twisting, squeezing, rubbing, twisting, gripping, grasping, etc., all apply force with both hands (or two fingers) at the same time. There are also lifting forces such as pinching, twisting, and pulling, which are also called lifting and pinching.

4. Counterforce such as pulling, traction, oblique pulling, etc., are all exerting force in the opposite direction.

5. Motion joints such as shaking, pulling, backing, etc., are passive motion joints. These manipulations are all comprehensive movements. In the process of completing a manipulation, several movements are included, so the direction of force application It is also multifaceted, and it changes with the changes of actions.

Second, the basic requirements of the operation
Although there are many kinds of techniques and different styles, the basic requirements for the techniques are the same. They must be durable, powerful, even, and soft to achieve the purpose of penetration.The technique must be practiced according to the requirements in order to get twice the result with half the effort.This is a summary of the experience of the predecessors after long-term practice. 1. Persistence means that during the operation process, the technique can be continuously used in strict accordance with the specified technical requirements and operating specifications, without losing shape within a sufficient time, and maintaining the continuity of movements and strength, intermittently, so as to ensure the effect of the technique on the human body. The stimulation is enough to accumulate to the critical point, so as to adjust the function of internal organs and change the pathological state.

2. Powerful means that the manipulation must have a certain strength and skill during the operation, so that the manipulation has a certain amount of stimulation.Therefore, forceful, one refers to the force that the manipulation directly acts on the body surface; the other refers to the force required to maintain the manipulation.Powerful technique is one of the conditions an operator must have. Power does not simply refer to great strength, but a kind of skill.It should be changed and applied according to the object of treatment, the operation site, the nature of the manipulation, the deficiency and excess of the disease, and the constitution of the patient, so as to adjust the size of the force and apply the appropriate manipulation force.Therefore, the basic principle of using force is to maintain the therapeutic effect and avoid adverse reactions.Generally speaking, when operating the muscle-rich parts (such as the waist and hips), the force can be slightly heavier, while the muscle-weak parts (such as the chest and abdomen, head and face) can be operated with slightly lighter force; for young and middle-aged patients, the force can be slightly heavier. ; For old and young patients, the force should be slightly lighter.In addition to seasons and climates, such as autumn and winter, when the skin interstitial texture is dense, the force should be slightly heavier during treatment. On the contrary, in spring and summer, the skin interstitial texture is looser, and the force should be slightly lighter.In short, insufficient or excessive manipulation force will affect the therapeutic effect, and proper manipulation force can be mastered only after long-term practice according to specific clinical conditions.

3. Uniformity means that when the manipulation is performed, the range of movement, the speed of the speed, and the severity of the pressure of the manipulation must be kept relatively consistent. The manipulation should be smooth and rhythmic.

4. Gentleness refers to gentle and flexible movements when the manipulation is performed; natural and coordinated movements when changing manipulations.Make the technique light but not buoyant, heavy but not stagnant.Therefore, meekness does not mean being weak or weak, but that the force must be moderate, and the technique should not be harsh.

5. Deep penetration refers to the patient's response to manipulation stimulation and the therapeutic effect of manipulation on diseases.Deep penetrating requires the stimulation of techniques, which not only act on the surface of the body, but also overcome various resistances, so that the effects of manipulation can be transmitted to the inside, reaching the deep muscles, muscles, and even viscera.

The above aspects are closely related, complement each other and penetrate each other.The continuous use of manipulation can gradually reduce the tension of the patient's muscles and the viscosity of the tissue, so that the skill of the manipulation can gradually penetrate deep into the tissue.Uniform and coordinated movements can make the technique softer.The combination of strength and skill means that the technique is both powerful and soft, reaching the state of "combining hardness and softness".In clinical application, strength is the foundation, technique is the key, both must have both, neither can be dispensed with.If you have plenty of physical strength, you can give full play to the technique and use it with ease. On the contrary, if you lack physical strength, even if the technique is superb, it will be difficult for you to use it.Dripping water through stone is not a one-day achievement. To make the technique durable, powerful, uniform, and soft, to achieve the state of softness in the rigidity, rigidity in the softness, and the combination of rigidity and softness, you must study hard and practice hard, so that you can become familiar from birth, and familiarity makes perfect , and even handy and easy to use.

[-]. Matters needing attention in operation

Manipulation is used clinically as an external treatment method. Although it has good medical effects on many diseases, it may also cause some adverse reactions due to improper operation and other reasons.Therefore, the following issues must be paid attention to during operation:
1. The diagnosis should be clear

Before manipulative treatment, it is first necessary to make a clear diagnosis, exclude diseases that are not suitable for treatment, choose the correct body position, appropriate manipulation, and necessary parts, and never blindly perform surgery.

2. Concentrate

During the manipulation process, concentrate on it.In addition to maintaining a clean and quiet environment in the consulting room, the surgeon must also concentrate on moving the hands freely and the work comes from the hands. At the same time, they must also pay close attention to the patient's reaction to the manipulation (such as changes in facial expressions, muscle tension, etc.). passive movement resistance, etc.), to adjust the method and intensity of manual stimulation at any time, so as to avoid increasing the patient's pain and unnecessary artificial injury.

3. Posture should be appropriate
When performing manipulations, choose the appropriate body position.For the patient, it is advisable to choose a position that feels comfortable and relaxes the muscles, which can be maintained for a long time and is also conducive to the doctor's manipulation.For the operator, it is advisable to choose an operating position that is convenient to operate, and is conducive to the use of the technique and the exertion of strength.At the same time, it is also necessary to achieve attention, body and hands, and the footwork changes accordingly with the technique.During the whole operation, the movements of all parts of the operator's body must be coordinated.

4. The method should be selected
There are many kinds of techniques and many changes.There are more than 100 basic techniques and more than 400 other techniques in written records.The technique to be used in the course of treatment is like a prescription for medicine. It should depend on the nature of the disease, the location of the lesion, and the identification of the disease.

(1) Selection of methods for differentiating symptoms and diseases: for acute soft tissue injuries, thenar kneading, rubbing, rubbing, etc. with light pressure and gentle manipulations should be selected; for chronic soft tissue strains, pointing and elbow pressure with strong stimulation can be selected. method, plucking method, clapping method, etc.; for those with joint movement disorders, the shaking method, stretching and bending method, etc. are often used; for joint dislocations, joint rehabilitation methods should be used, such as pulling method, pulling method, etc.; for those with adhesions , you should use the pulling method, elastic tendon pulling method, tendon regulation method, etc.

(2) Select the manipulation according to the site: For those with small lesions, superficial sites, or weak muscles, the manipulation with gentle stimulation and strong penetrating effect should be selected; otherwise, the manipulation with large contact area and strong stimulation should be selected.

The selection of the above-mentioned opponent techniques is only in general terms. In clinical practice, there are also issues such as the degree of mastery of techniques by the operator, personal habits of using techniques, and the characteristics of each school. Therefore, the application should also be based on each individual's Master it flexibly through experience, which is the so-called "although the law is fixed, the flexibility depends on the person".

5. Strength should be appropriate
Manipulation must have a certain strength to achieve a certain stimulation intensity in order to obtain therapeutic effect.Clinically, it is necessary to master the appropriate stimulation intensity.First of all, it is necessary to understand the factors related to the intensity of stimulation. The intensity of manual stimulation is often related to the pressure of the manipulation, the treatment site, the area of ​​force, the way of force, and the operation time.

(1) Manipulative pressure: As a general rule, the stimulus intensity is directly proportional to the manipulative pressure, that is, the greater the pressure, the stronger the stimulus.

(2) Treatment site: The strength of manipulation is related to the sensitivity of the treatment site and the thickness of the muscle layer at the treatment site.If the technique of the same pressure is used to operate on the more sensitive parts of the meridians and acupoints, the force will be stronger, while the application on non-meridian and acupoints will be relatively less stimulating.Also use a certain amount of pressure to act on the more developed muscles of the waist and buttocks. Generally, the strength is acceptable, but if it is used on the less developed muscles of the chest and abdomen, it will be unbearable.If the pressure used to treat adults is used on infants, it will cause adverse consequences.Therefore, for young and middle-aged people with muscular muscles, the strength of the manipulation should be appropriately increased to enhance stimulation; for the elderly or children with weak muscles, the strength of the manipulation should be lightened to avoid unnecessary injuries.In the early stage of soft tissue injury, local swelling, sharp pain, the pressure of manipulation should be light; for persistent pain, strain, dull sensation and numbness, the stimulation of manipulation should be heavier.If you have been ill for a long time and are weak, it is advisable to use light force; if you are newly ill and weak, you should use more force.

(3) Area of ​​effort: The strength of the technique is related to the area of ​​effort, generally inversely proportional.For the same pressure, if the force area is too large, the stimulation intensity will be small; on the contrary, if the force area is small, the stimulation intensity will be large.

(4) Force method: refers to the form of technique application and the speed of force.The impact force is much stronger than the slow stimulus.For example, percussion techniques, such as punching back punching and acupoint acupuncture, act on the human body in the form of impact force.This type of technique is vigorous and powerful, and special attention should be paid to the skill of the movement and the selection of appropriate strength during operation.

(5) Operation time: Generally speaking, the operation time is short and the stimulation volume is small; the operation time is long and the stimulation volume is large.Therefore, if the operation time is too short, the therapeutic effect will not be achieved, but if the operation time is too long, iatrogenic damage to local tissues may also occur.Therefore, the operation time should be determined according to the nature of the technique, the nature of the disease and the size of the operation range.

6. Treatment should be orderly

The order of manipulation should be determined according to the condition. Generally, it can be performed from the head and face → chest and abdomen → shoulders and back → lumbosacral → upper limbs → lower limbs, from top to bottom, first left and then right, from front to back, from shallow to deep, step by step, and according to specific conditions ,Appropriate adjustments.Local treatment is carried out according to the primary and secondary techniques.The intensity of manipulation gradually increases from light to severe; the range of motion of joints gradually increases from small to small; the operation speed gradually increases from slow to fast.For those who are weak and lack of energy and blood, manual stimulation should not be too strong.

7. Be flexible with your time

The time for the operation should be determined according to the patient's condition, constitution, and the techniques used.The time is generally 10-20 minutes, and it can be increased for internal medicine and gynecological diseases.It also depends on the size of the lesion.

8. The operation should be hygienic

Physicians should pay attention to personal cleanliness, trim nails frequently, and do not wear rings and other decorations on their hands, so as not to scratch the patient's skin and affect the treatment.When the weather is cold, keep your hands warm to avoid muscle spasms caused by cold hands touching the skin. After treating a patient, you should wash your hands to prevent cross-infection.

[-]. Contraindications of manual therapy

Manipulation is a medical method that uses standardized technical movements to directly act on specific parts and acupuncture points on the human body surface to prevent and treat diseases.According to the current situation of clinical treatment of massage, the contraindications of manipulation are as follows:

1. The site of a malignant tumor should generally not be manipulated to prevent the spread and metastasis of tumor cells and aggravate the condition.

2. The fracture site should not be used rashly, so as not to cause dislocation of the fracture site, damage to nerves, blood vessels and surrounding soft tissues, or become an open fracture.If the fracture is clear, manual reduction or bandaging and fixation of the fracture can be used to apply gentle manipulation to the distal end of the fracture site, which can promote fracture healing and reduce the occurrence of fracture sequelae.

3. The part that is bleeding or internal bleeding should not be treated by manipulation.Even if the extremities and joints are sprained and local swelling is painful, cold compresses should be applied first to stop the bleeding. After the internal bleeding stops, manual treatment can be used to avoid aggravating the local bleeding and causing adverse consequences.For patients with cerebral hemorrhage, manual therapy should be performed 2 weeks after the hemorrhage stops.

14. Generally, manipulative treatment is not used for skin diseases, such as eczema, ringworm, herpes, abscess, etc.

5. Skin damage, water and fire burns, the affected area should not be treated with manual therapy to avoid local infection.Even if the local sprain is accompanied by skin damage, manual therapy should be performed after the wound has healed.

6. Manipulative treatment is not suitable for sports organ diseases caused by tuberculosis bacteria, so as not to cause further damage (lumbar spine tuberculosis, hip joint tuberculosis, etc.).

7. Joint diseases caused by suppurative bacteria should not be treated by manipulation, so as not to aggravate the condition (suppurative knee arthritis, etc.).

8. During women’s pregnancy and menstrual period, manual therapy is not suitable for the lumbosacral region and abdomen (it is also not advisable to use strong stimulation on acupoints with strong sensitivity on the limbs). Other parts need manual therapy, and gentle and comfortable methods should also be used. .To avoid miscarriage and excessive bleeding.

9. After strenuous exercise, when hungry, extremely tired or extremely weak patients, it is not advisable to undergo manipulation therapy immediately to avoid syncope.

10. Drunken and other delirious people generally do not receive manual therapy immediately.

[-]. Handling of abnormal situations
1. Ecchymosis is the phenomenon of subcutaneous bleeding during and after massage treatment.

(1) Clinical manifestations: During and after the massage treatment, the patient experienced subcutaneous hemorrhage at the treatment site, local skin swelling, and bruising, purpura and ecchymosis.

(2) Causes: The manual stimulation was too heavy and the time was too long during the initial treatment; the patient suffered from thrombocytopenia; the fragility of capillaries increased in old age.

(3) Treatment: local small ecchymosis generally does not need to be treated.If the local bruising is severe, you can first relieve the pain and apply cold compresses. After the bleeding stops, use gentle massage, rubbing, rubbing and other techniques on the local area for treatment.At the same time, humidify and heat compress to reduce swelling, relieve pain, and promote local blood stasis to dissipate and absorb.

(4) Prevention: If it is not necessary, it is not advisable to use excessively stimulating techniques for treatment.Elderly people must use gentle manipulations, especially on the parts with protruding bones, and the stimulation of manipulations should not be too strong.For patients with acute soft tissue injury, do not rush to manual therapy and use hot and humid compresses. Generally, they can be used together 1 to 2 hours after the subcutaneous bleeding stops.

(End of this chapter)