Showing posts with label Tuina. Show all posts
Showing posts with label Tuina. Show all posts

Wednesday, December 2, 2015

The Four Pillars of Chinese Medicine

Acupuncture is Just One Pillar of Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) is a comprehensive medical system from China. While many people are aware of acupuncture, TCM actually incorporates four major avenues or treatment. These are known as “the four pillars” of TCM, and they are: acupuncture; Chinese herbal medicine and dietary therapy; Tuina, which incorporates medical massage and manipulation; and exercise and movement therapy. Your trained Doctor of Oriental Medicine will evaluate your case and prescribe one or several of these treatments depending on what is needed.

Acupuncture involves the use of very thin, single-use, sterilized needles inserted in various locations to regulate body processes. In the West, acupuncture is most often used for pain relief, for which it is very effective. But this is not the full scope of comprehensive acupuncture treatment; it is actually appropriate in a wide range of illnesses.

Chinese herbal medicine is based on a vast array of medicinal formulas, which are therapeutically balanced combinations of herbs used to treat patterns of medical disharmony. TCM looks for clinical signs and symptoms of these patterns and then prescribe specific herbal medicinal formulas to treat these patterns. TCM pattern differentiation and treatment with herbal Medicinals can offer a safe and effective natural treatment for illness or can complement your treatment prescribed by your Western MD, in some cases possibly enabling your Western pharmaceutical prescription to be reduced or helping deal with side effects.

In addition to the prescription of herbal Medicinals, dietary recommendations can also be used as part of the treatment. This can include general assistance with weight loss or maintenance, or specific food choices and preparations designed to help you manage an existing condition.

Tuina is a Chinese system of clinical massage and joint mobilization. Tuina is derived from two words; tui meaning to “to push” and na meaning “to lift and squeeze”. Tuina uses light, moderate, or deep pressure to mobilize the body’s structures and joints and restore normal movement. It is primarily used for musculoskeletal conditions, but it can also be employed for other condition such as respiratory or digestive problems. Generally, Tiuna focuses on particular regions such as the neck, back, legs, etc., and resembles more clinical styles of Western deep tissue massage therapy. Click here to see a previous post about Tiuna.

Finally, Therapeutic Exercises are often prescribed in China to help treat illness and to maintain and improve health. In particular, tai chi (Taiji) and qigong are therapeutic forms of exercise that improve flexibility, circulation and general wellbeing.

When looking for a practitioner of Traditional Chinese Medicine, it is important to understand that many practitioners focus mostly on one or maybe two of these ‘pillars’ listed above, usually based on a practitioner’s specialization. Practitioners focusing on internal medicine might use herbs more extensively while those treating musculoskeletal pain might be inclined to use Tiuna more. In my clinical practice, I specialize in the treatment of sports injuries and orthopedic pain conditions. So, I primarily focus on acupuncture, Tiuna, and corrective exercises to facilitate rehabilitation from injury, and to correct muscle imbalances that contribute to pain conditions. When I prescribe herbal medicine, it is usually a formula (balanced combinations of herbs) to help with the particular pain or injury. Such herbal formulas may help with trauma; they may address how the body deals with inflammation, or they may regulate the nervous system to reduce over-contraction and tightness in the muscles. The herbs basically support the treatment, while the acupuncture, Tiuna and therapeutic exercise prescription specifically target the region of pain and return normal movement to the body.

Another practitioner who specializes in internal medicine might rely much more on herbs, and their acupuncture treatment might be more supplemental. It is important for patients to know what to look for when seeking a practitioner, as not all have equal training and not all have experience that will make them effective in treating all medical problems.

Most TCM practitioners do use these four pillars, but there is no need to be dogmatic about using only techniques that originated in historical China. If a modern or Western-developed treatment protocol is appropriate and compatible with TCM principles, it can be integrated into a Four Pillars-based treatment plan. For instance, to reduce inflammation, I might prescribe a classical herbal formula, but I might also prescribe fish oil supplementation. Also, I frequently use manual massage techniques and mobilization of joints, but much of my training comes from Western bodywork systems such as myofascial release and structural integration (I am certified in both of these via the CORE Institute). On an even deeper level, my acupuncture treatments rely heavily on Western anatomy and Sports Medicine principles. These techniques are taught in AcuSport Seminar Series and the Sports Medicine Acupuncture Certification Program, on whose faculty I serve. My point is that as Chinese medicine becomes more global, it can include insight from many other viewpoints, especially Western medicine, but the heart of the medicine will continue to focus on these four basic pillars of treatment which are designed to return the body to a balanced state of health.


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Myofascial Release

What is Myofacial Release?


Myofascial release is a deep-tissue work whose focus is to relieve pain, resolve structural dysfunction, and improve function, mobility, and posture. “Myofascia” refers to the combined anatomical system of muscles (“myo”) and fascia. Fascia is a continuous web of connective tissue found throughout the entire body, It surrounds every muscle, nerve, blood vessel, and organ, and holds all these structures together, giving them their shape, offering support and interconnecting the body as a whole.

Myofascial release has its roots in Connective Tissue Massage (Bindegewebsmassage) which was developed by Elizabeth Dicke who lived in Germany in the 1920s and 1930s. This work consisted of light strokes whose theoretical purpose was to improve circulation in subcutaneous connective tissue, resulting in reflex action to other parts of the body, including visceral organs.
Hands doing myofascial release massage to a back.
Myofascial Release to the Lower Ribcage

The term “myofascial release” was coined by Robert Ward, DO, (Doctor of Osteopathy) in the 1960s. John Barnes, PT, (Physical Therapist) adopted the term as designation for his method of freeing fascial restriction, and this is a popular form of myofascial therapy practiced today.

Another important figure in the development of myofascial therapies, and someone whose work more directly influences my own, was Ida Rolf, PhD who taught in the 1960s and 1970s. Dr. Rolf developed a ten-session series of work that she called Structural Integration and that later was trademarked as RolfingTM. Dr. Rolf was very influenced by osteopathic manipulation; through her ten-session series, she sought to re-establish vertical alignment in the body by manipulating fascial layers. I studied this work in 2002-2003 at the CORETM Institute with George Kousaleos and, upon certification, I continued my education, studying with Certified Advanced Rolfer Liz Gaggini and also studying with KMI/Anatomy Trains faculty (Tom Myers, James Earls, and Simone Lindner).

Simone Lindner, while still maintaining a busy teaching schedule with KMI, is currently serving on our faculty in the Sports Medicine Acupuncture Certification Program, where she teaches Anatomy Trains principles in the Fascial Release for Myofascial Meridians (FRMM) course. This has been an extremely rewarding experience, as I teach in the Anatomy, Palpation and Cadaver Lab in a two-day course prior to the FRMM course, where I lecture on the sinew channels discussed in the Chinese meridian system. These have much crossover with the anatomy discussed in the anatomy trains system.

After my class, Simone then teaches fascial release techniques to work with these lines to restore structural balance. I assist with this class and occasionally help relate this information into TCM language more familiar to acupuncturists. This has been a tremendous amount of fun and a very educational experience for me personally, as well as for class participants. Matt Callison (the director of SMAC) and I then follow up and review some of these techniques in the Assessment and Treatment class, which usually takes place about a month later. In this class we teach assessment of injuries and conditions and using the assessment results to build treatment protocols, primarily geared around acupuncture, but also prominently featuring myofascial release techniques.

Much of this work, in addition to work from other Structural Integration practitioners (my original teacher, George Kousaleos, and a current influence of mine, Advance Rolfer Til Luchau) has made its way into a course I am teaching at East West College of Natural Medicine. I teach many classes there, including Anatomy and Physiology, Orthopedic Evaluation, and Acupoint Anatomy, but more and more I have been teaching myofascial release techniques as part of the Tuina curriculum. The goal is to make this work accessible to acupuncture physicians in training so that they can improve the therapeutic outcome of their treatments and more deeply understand the sinew channels and how they relate to global strain patterns. To see more on this, visit my past blog post Teaching and Tuina.


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Teaching and Tuina

Structural Integration, Myofascial Release and Crossover with Tuina

Yesterday and today I gave exams for the Summer term at East West College of Natural Medicine where I am a faculty member. This term I taught some classes that I regularly teach, such as Anatomy and Physiology, Oriental Medicine Physiology, and Orthopedic Evaluation. The class I enjoyed teaching the most this term, however, was Tuina.

Myofascial Release to the Infraspinatus Muscle

Tuina is a Chinese system of clinical massage and manipulation/joint mobilization. This class allows me to draw on my clinical experience with structural integration, which I studied and practiced before going back to school for Chinese medicine and acupuncture. Many people know this work as Rolfing, as the original body of work was developed by Dr. Ida Rolf, PhD. This work uses deep tissue myofascial release applied to shortened, densified connective tissue and muscles (myo-muscle, fascia-connective tissue) with the goal of realigning the body and helping integrate movement patterns. This work is often performed in a ten-session series, with each session having a particular goal (opening restrictions in breathing, balancing the weight in the feet, etc.).

While there are many excellent schools that teach this work, many talented SI practitioners and Rolfers teach aspects of this work to therapists who want to apply it to their existing work flow. This has been my goal with teaching this work at a Chinese medicine and acupuncture program. I teach how strain patterns tend to manifest in the body, how to assess for them, and then some manual release techniques and how to include them in combination with a more integrated acupuncture treatment. What I have found is that this work syncs very well with acupuncture and Chinese medicine.



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