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Tui Na: Chinese Massage or Something More?

By Narda G. Robinson, DO, DVM, MS, FAAMA

Veterinary Tui Na, or Chinese bodywork, has recently joined the Traditional Chinese Medical repertoire along with TCM-style acupuncture and food therapy. Proponents point to the antiquity of Tui Na, citing its origin as circa 1700 BCE.¹

Why some practices survived so long, however, is that the closed society of China kept its medicine primitive and folkloric until the Communist Revolution. Today, TCM risks extinction in China because of decreasing enrollment and interest by medical students.² 

Calls for the “abolition of traditional Chinese medicine” have erupted in scholarly circles due its lack of scientific basis and outdated precepts.³ Even TCM hospitals are adopting more Western medical style diagnostics and relying less on techniques such as tongue and pulse diagnosis.⁴

China is now banking on the West’s appetite for all things Asian to keep TCM alive as well.⁵ Indeed, Americans have transformed both TCM and its veterinary counterpart, TCVM, into big business. It is curious to note that as China works to upgrade its veterinary medical educational standards to meet those outside of China,⁶ some U.S. holistic groups point to TCVM as a gold standard.⁷,⁸

However, the wholesale importation of unproven TCVM techniques such as Tui Na carries risk, much like other untested Chinese products. When Tui Na practitioners advertise their actions as moving invisible “chi” energy, in reality neither chi-energy nor invisible conduits (i.e., meridians) for this made-up energy exist.⁹ 

The pushes, pulls, grasps and rolls of Tui Na, as exotic as they sound in Chinese (i.e., “An Fa,” “Mo Fa,” “Na Fa” and “Rou Fa”) are merely influencing soft tissue, much like massage.¹⁰ So, what harm is done if animal masseuses use Chinese terms and allude to imaginary energy movement instead of describing their soft tissue manual therapy techniques as legitimately affecting muscles, tendons, vessels and nerves?

The problem of indulging mysticism in medicine is that the modality falls out of reach of research and validation.  While it is difficult to find any scientific studies in English that evaluate Tui Na as a sole intervention, research on Western soft tissue techniques is soaring and demonstrating benefit. For example, a retrospective study evaluating 10 sessions of Rolfing structural integration showed that patients experienced significant pain reduction and increased active range of motion.¹¹ 

A 2009 report in the Clinical Journal of Pain showed that Western-type therapeutic massage for chronic neck pain was safe and beneficial.¹² Therapeutic massage outperformed TCM-style acupuncture for chronic low back pain.¹³

Research on Tui Na, in contrast, remains sparse. One systematic review and meta-analysis of the efficacy of Tui Na for humans suffering from cervical spondylosis failed to support Tui Na.¹⁴ A case report on alternative treatments for a cat with multifocal intervertebral disc disease incorporated a slew of techniques, including scalp acupuncture, electro-acupuncture, dry needling therapy, Tui Na and physical therapy in addition to high dose prednisolone therapy and tincture of time. This left the reader perplexed as to which, if any, of these techniques actually helped, and whether any treatments addressed pain or only motor function.¹⁵

If Tui Na ever does receive suitable research attention, the physiologic improvements derived from its soft tissue techniques would likely resemble those from Western-style massage and point to reduced pain and stress, improved immune function and restored autonomic nervous system regulation.¹⁶ The veterinary profession’s awakening to chronic soft tissue pain experienced on a day to day basis definitely needs a boost, and in some ways, Tui Na could help meet this need. 

The biggest problem facing both Tui Na and the profession involves its incorporation of bonesetting techniques that look like chiropractic.¹⁷,¹⁸ Tui Na practitioners “adjusting” necks and backs while focusing on chi blockages rather than joint mechanics could misdiagnose problems and unwittingly cause injury.

That Tui Na includes “manipulation techniques to realign the musculoskeletal and ligamentous relationships”¹⁹ raises issues about the safety and appropriateness of Tui Na for animals. In China, a report of acute tetraplegia in a human following spinal manipulation by a bonesetter underscores these concerns.²⁰

It is challenging to say exactly who should perform high velocity manipulative techniques (i.e., “adjustments”) on animals given the lack of scientific evidence of benefit and safety. In the human field, however, a battle has already taken place between acupuncturists and chiropractors. 

Human acupuncturists tried to strenuously defend their right to perform Tui Na, but one state (Texas) determined that Tui Na falls outside of the statutory definition of the practice of acu-puncture.²¹ Then-Texas Attorney General John Cornyn rendered his opinion based on what he’d learned from the president of the Texas Board of Chiropractic Examiners. The Board had received several complaints of patients being “injured by acupuncturists who were allegedly performing spinal manipulations,” or Tui Na.²² 

No matter what one calls these techniques, high velocity manipulation to the cervical spine can lead to stroke, myelopathy radiculopathy and death.²³ 

Seeing that a  Chinese how-to guide on Tui Na²⁴ advocates “neck twisting” and “pulling” “with a forceful movement” until one hears a “cracking sound,” the time has come for Western practitioners to reconsider their open invitation to all things TCM pending suitable explanations for how they help and how they might hurt. <HOME>

Narda Robinson, DVM, DO, Dipl. ABMA, FAAMA, oversees complementary veterinary education at Colorado State University.

This article first appeared in the December 2009 issue of Veterinary Practice News

FOOTNOTES:

1. Dune L.  Integrating Tuina acupressure and Traditional Chinese Medicine concepts into a holistic nursing practice.  Explore.  2006;2(6):543-546.

2. Anonymous.  Beginning of end for TCM?  April 4, 2009.  Chinadaily.com.cn.

3. Anonymous.  TCM faces homegrown challenges.  August 27, 2008.  Chinadaily.com.cn.

4. Anonymous.  TCM faces homegrown challenges.  August 27, 2008.  Chinadaily.com.cn.

5. Anonymous.  Experts urge more TCM use.  April 15, 2009.  Chinadaily.com.cn.

6. Yin J-C, Li G-X, and Ren X-F. An overview of veterinary medical education in China:  current status, deficiencies, and strategy for improvement.  JVME.  2006;33(2):238-243.

7. American Academy of Veterinary Acupuncture Continuing Education programs.  Listed here at on 10-21-09.

8. American Association of Traditional Chinese Veterinary Medicine.  Click here.  Obtained on 10-21-09.

9. Dune L.  Integrating Tuina acupressure and Traditional Chinese Medicine concepts into a holistic nursing practice.  Explore.  2006;2(6):543-546.

10. O’Neill JA.  Tui Na:  TCVM bodywork – part 2:  learning technique.  NAVC Conference 2009, p. 52.

11. James H, Castaneda L, Miller ME, et al.  Rolfing structural integration treatment of cervical spine dysfunction.  Journal of Bodywork and Movement Therapies.  2009;13:229-238.

12. Sherman KJ, Cherkin DC, Hawkes RJ, et al.  Randomized trial of therapeutic massage for chronic neck pain.  Clin J Pain.  2009;25(3):233-238.

13. Cherkin DC, Eisenberg D, Sherman KJ, et al.  Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain.  Arch Int Med.  2001;161(8):1081-1088.

14. Wang M-Y, Tsai P-S, Lee P-H, et al.  Review.  Systematic review and meta-analysis of the efficacy of tuina for cervical spondylosis.  Journal of Clinical Nursing.  2008;17:2531-2538.

15. Choi KH and Hill SA.  Case report.  Acupuncture treatment for feline multifocal intervertebral disc disease.  Journal of Feline Medicine and Surgery.  2009;11:706-710.

16. Anhui Medical School Hospital/China.  Chinese Massage Therapy.  A Handbook of Therapeutic Massage.  Boulder:  Shambhala, 1983.  Pp. 3-7.

17. Helm B.  Tui Na – Chinese bodywork therapy.  Obtained here on October 17, 2009.

18. Ferguson B.  Veterinary Tui Na.  Small animal and exotics.  Book one:  Alternative medicine – orthopedics.  Proceedings of the North American Veterinary Conference. Volume 18, Orlando, FL, USA.  17-21 January 2004. Pp. 23-24.

19. Helm B.  Tui Na – Chinese bodywork therapy.  Obtained here on October 17, 2009.

20. Chung OM.  Case report.  MRI confirmed cervical cord injury caused by spinal manipulation in a Chinese patient.  Spinal Cord.  2002;40:196-199.

21. John Cornyn, Attorney General of Texas.  Letter to Cynthia S. Vaughn, DC, dated May 23, 2001.  Obtained here on October 17, 2009.

22. Editorial staff.  Texas Atty. General says Tui Na NOT part of acupuncture.  Chiropractor’s letter leads to restriction of practice.  Acupuncture Today.  Obtained here on October 17, 2009.

23. Chung OM.  Case report.  MRI confirmed cervical cord injury caused by spinal manipulation in a Chinese patient.  Spinal Cord.  2002;40:196-199.

24. Chen P (editor in chief).  Chinese Tuina and Therapeutic Applications.  Beijing:  Science Press, IOS Press, Ohmsha,  1998.  P. 105. 

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Tui Na: Chinese Massage or Something More?

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Sandy, Thank you for submitting your reflections on my piece. I urge you to re-read the article; it is by no means "a blanket condemnation on the basis of poor practitioners". Please note that my main contention is summed up in the following statement: "The problem of indulging mysticism in medicine is that the modality falls out of reach of research and validation". I support the application of scientifically based soft tissue techniques in veterinary medicine, because I recognize their substantive value in the clinic. What I do NOT support, however, is the perpetuation of myth and belief systems in medicine. You yourself state that "I don't understand the meridians and the flow of Chi..." and then leap to the justification about why it's okay to not understand it, because as you say, "I can testify that this stuff works". I find it sad that when I hear people being led to believe that Tui Na works by moving invisible energies through invisible meridians. You rightly don't understand the explanation that Tui Na practitioners offer because it's not correct. Dr. Narda, Fort Collins, CO Posted: 12/21/2009 7:29:47 AM I hate to see Tui Na receive a blanket condemnation on the basis of poor practitioners. Unfortunately, both human and veterinary medicine have practitioners who have diagnostic or operational deficiencies, but that is not a reason to condemn what they are attempting to do. Tui Na, when done properly, is not a quick and violent adjustment. It involves thoroughly relaxing the area, and preparing the muscles and connective tissue through gentle movement, before the “adjustment” is given. Two years ago, I received a back injury that left me with muscle spasms and pinched nerves in my lower back, sacroileitis, and bursitis in one hip. Over the course of three months, I became progressively more disabled, despite the best efforts of “Western” medicine. I saw my family practitioner, a family practitioner/former emergency room physician, and an orthopedic surgeon. I was treated with oral narcotic and non-narcotic analgesics, pain patches (lidocaine), muscle relaxants, sedatives, anti-inflammatories, exercise, rest, ice, heat, and a cortisone shot. My blood pressure, usually in the 100s/60s, soared to the 170s/130s. I finally went to see a licensed acupucturist/Tui Na practitioner, who came highly recommended by several of my co-workers. By that time, I was on crutches and in intractable pain. He treated me with Tui Na, and I was able to walk, on my own, up the stairs to leave, with no significant pain. By three days later, I was able to walk with no problem and no pain, although going backward was still risky. I made another appointment and, three days after the second Tui Na treatment, I was able to folk dance, with rapid forward, backward, and sideways movements and stamps, with no difficulty, no pain, and no drugs. I don't understand the meridians and the flow of Chi, but I can testify that this stuff works, in the right hands. My family practitioner agreed that often, in cases like this, alternative medicine is the appropriate treatment, although he hadn't suggested that I try it. We have recommended this Tui Na practitioner to many of our acquaintances, and they have all been delighted. I only wish that he treated animals, but he knows his limitations. Sandy Birkenmaier Technician at the Virginia-Maryland Regional College of Veterinary Medicine, at Virginia Tech, for 14 years Sandy, Riner, VA Posted: 12/17/2009 10:59:01 AM