I. Learn the basic Tuina manipulations for adult.

II. Understand the steps and special techniques of each manipulation

III. Know the essentials and cautions of each manipulation.

IV. Arduously practice the manipulations.

Definitions

Manipulations in Tuina are the standard techniques

performed with the doctor’s hands or other parts of the body
for stimulating the affected parts of the patient.
Basic requirements for Tuina manipulations

 Continuously “持久” -operating for a standard period of time

 Forcefully “有力” -applying the appropriate force base on

individual body condition and body parts

 Evenly “均匀” -maintaining a rhythmic force with pressure

within a certain range

 Softly “柔和” -manipulating a gentle and ease force instead

violent and abrasive

 Thoroughly “深透” -achieving a effect on deep tissue layer

Training for manipulation

• Fingers

• Wrist

• Arms

-practitioners have to train their fingers, wrists and arms by means of push-up,
dumbbell and spring-grip dumb-bells.
Physical exercise (Qi-gong) for healthcare and training

 五禽戏 （Wu Qin Xi）

 八段锦（Ba Duan Jin）

 太极拳（Tai Chi）

 灵子术（Ling Zi Shu）

 易筋经（Yi Jin Jing）

The basic manipulations can be classified into:

 Swaying （摆动类）

 Rubbing （摩擦类）

 Vibrating （振动类）

 Pressing （按压类）

 Percussion （叩击类）

 Joint movement（活动关节类）
 • One-finger pushing “一指禅推法”
• Rolling “滚法”
(1)Swaying“摆动类”
• Kneading “揉法”

• Stroking “摩法”
• To-and-fro rubbing “擦法”
(2)Rubbing“摩擦类” • Pushing “推法”
• Wiping “抹法”
• Palm-twisting “搓法”

• Vibrating “振法”
(3)Vibrating“振动类”
• Shaking “抖法”

Basic manipulation • Point-pressing “按法”

• Suppressing “压法”
• Pinching
(4)Pressing“按压类” “捏法”
• Grasping
“拿法”
• Finger-twisting “捻法”
• Plucking “拨法”
• Patting “拍法”
(5)Percussion“叩击类” • Hitting “击法”
• Flipping “弹法”

• Rotating
(6)Joint movement
“摇法”
“活动关节类” • Pulling-extending “拔伸法”
• Pulling “扳法”
 Yi Zhi Chan Fa (One-finger pushing manipulation)

-exert force by swaying the forearm and direct it to the

affected area or Acupoint with the tip or the whorl surface
of the thumb

【Methods】

• Clench a hollow fist with suspended and flexed wrist and palm
• And stretch the thumb straight naturally to cover the fist hole
• Exert force on the body surface with the tip or the whorl surface of the
thumb
• Lower the shoulder, drop the elbow and suspend the wrist
• Sway the forearm initiatively to bring the wrist swing inward and
outward while flexing and extending the thumb joint to make the force
on the Acupoint heavy and light
• The frequency of 120-160 times per minute
【Essentials for performing
manipulations】

1. Lowering shoulders

2. Dropping elbow

3. Suspending wrist

4. Exert force of thumb

5. Pushing forcefully and moving slowly

【Cautions】

1. The shoulders, elbow and wrist should be kept relaxed, but not lax.

2. Operating one-finger pushing manipulation on the surface should

follow the principle of “ pushing along the meridians and collaterals,
and moving along the Acupoints”. Select the Acupoints along the
meridian.
Appendix: The evolvement of one-finger pushing manipulation

1. Yi Zhi Chan Pian Feng Tui Fa (Lateral-pushing

of the one-finger pushing manipulation)

• Exert force with the thumb-radius while

straightening and adducting the thumb
• Keep the palm and others fingers straight
• Slightly flex the wrist joint, sway the forearm
initiatively and the wrist joint gently
• Known as 少商劲 (Shao Shang Force)

 Suitable to perform on the craniofacial region (light

stimulation)
2. Yi Zhi Chan Qu Zhi Tui Fa (One-finger pushing
manipulation performed with flexed thumb)

• Flex the thumb with the force exerted from the radial
border or the back of the interphalangeal joint
• Known as 跪推法 (Gui Tui Fa)

 Often applied to the nape and bone cleft of the joint

(fixed and strong force)
 Gun Fa (Rolling manipulation)

-use the ulnar dorsum to press the affected region by

swaying the forearm to drive the extend and flex, and roll
on the affected area.

【Methods】

• The practitioner straightens the thumb naturally and makes a hollow

fist
• The little finger and the ring finger flex naturally to 90°
• Flexed angle of the other two fingers reduces gradually to make the palm
round along the palm surface
• Press the affected area with dorsum of the hand
• Sway and rotate the forearm initiatively to extend and flex the wrist in a
wide range
• The swaying frequency is about 120times per minute
【Essentials for performing
manipulations】
1. Low shoulders and drop elbow with the wrist joint flexed naturally
to 14°.

2. The wrist joint extends and flexes about 120°;flexing the wrist joint
80°while swaying outward about 40°.

3. The stimulation should be done with light and heavy force

alternately, rolling forward three times and rolling back once.

4. The frequency should be fixed. The speed should not be too quick.

5. While one hand is performing rolling manipulation, the other hand

can help the patient do passive movement. Two hands should be
coordinative.
【Cautions】

1. When performing Gun Fa (rolling manipulation), the amplitude of the

wrist joint’s extending-flex movement should be maximized

2. Rotation of the forearm and insufficient extension and flexion of the

wrist joint should be avoided

3. Rolling manipulation should be fixed; hauling, leaping or rotating-

swaying is not allowed. Avoid bumping.

4. Operating on the apophysial joints of vertebral spinous process and

other joints should be avoided because it may cause discomfort
Appendix: The evolvement of rolling manipulation

1. Zhang Zhi Guan Jie Gun Fa (Rolling with palm

and phalangeal joint)

• Press the affected area with apophysial points of

palm and phalangeal joints
• Replace the complex movement of extension and
flexion of the wrist joint and the rotation of the
forearm with simple movement of extension and
flexion of the wrist joint

 Suitable for waist, buttock and lower extremities

2. Qian Bi Gun Fa (Manipulation of rolling with
forearm)

• Exert force on the affected area with the ulnar

dorsum side of the forearm and roll to and fro

 Applied on patients who are heavy or the waist,

buttock and lower extremities with larger area (soft
and comfortable stimulation)
 Rou Fa (Kneading manipulation)

-fix on the body surface with certain part of the finger and
palm and knead in circles to rotate slowly and softly the
subcutaneous tissues.

【Methods】

1. Da Yu Ji Rou Fa (Major thenar kneading manipulation)

• Exert force with major thenar and flex the wrist joint slightly to 120°-
140°
• Use the elbow joint as a pivot and sway the forearm initiatively to knead
with major thenar and sway on the affected area
• The frequency is about 120-160 times per minute
2. Zhang Gen Rou Fa (Major thenar kneading manipulation)

• Exert force with palm base

• Flex the fingers naturally and stretch the wrist joint slightly backwards
• Use the elbow joint which flexes slightly as a pivot and sway the forearm
initiatively to knead with the palm base on affected area
• The frequency is 120-160 times per minute
3. Mu Zhi Rou Fa (Thumb kneading manipulation)

• Exert force with palm base

• Flex the fingers naturally and stretch the wrist joint slightly
backwards
• Use the elbow joint which flexes slightly as a pivot and sway the
forearm initiatively to knead with the palm base on affected area
• The frequency is 120-160 times per minute

4. Zhong Zhi Rou Fa (Middle finger kneading manipulation)

• Exert force with the whorl surface of the middle finger

• Use the elbow as a pivot with the middle finger joint straightened
and the metacarpophalangeal joint flexed slightly
• The forearm rotates in an initiative small amplitude with the whorl
surface of the middle finger rotating
• With the frequency is 120-160 times per minute
【Essentials for performing
manipulations】
1. In perform kneading manipulation, the practitioner should lower the
shoulders, drop the elbow and relax the wrist joint.

2. The forearm sways in a small amplitude to rotate with force from the
wrist joint.

3. In performing kneading manipulation, subcutaneous tissues should be

activated to rotate with force from the wrist joint.

4. The pressure should be moderate, making the patient feel comfortable.

【Cautions】

1. In this manipulation, rubbing or slipping between the treated part and

the body surface should be avoided.

2. The force should be passed through the relaxed wrist joint.

3. When performing kneading manipulation, the wrist joint should be

relaxed with certain intensity, and avoiding excessive stiffness of the
wrist.
 Mo Fa (Circular-rubbing or stroking manipulation)

-Use the finger surface or palm to touch the affected area

and make rhythmic and circular movements.

【Methods】

1. Zhang Mo Fa (Palm-stroking manipulation)

• Press on the body surface with the fingers juxtaposed

• The palm straightened naturally and the wrist joint stretched slightly
• Use the elbow joint as a pivot, and move the forearm initiatively to rub
circularly with the palm on the affected area
• Can be performed either clockwise or anti-clockwise
• The frequency of 100-120 times per minute
2. Zhi Mo Fa (Finger-stroking manipulation)

• Take the palm side of the index finger, middle finger, ring finger and the
little finger as the touching area with the fingers justaposed
• The palm straightened naturally and the wrist joint flexed slightly
• Use the elbow joint as a pivot
• Move the forearm initiatively to rub with the palm side of the fingers
circularly on the affected area
• It can be performed clockwise or anti-clockwise
• The frequency of 100-120 times per minute
【Essentials for performing
manipulations】
1. In performing stroking manipulation, the shoulders should be relaxed
and the forearm should sway initiatively to enable the relaxed wrist
joint to make circular movements.

2. In performing stroking manipulation, the force should be moderate and

the frequency should be even.

3. The manipulation should be light but not superficial; heavy but not
stuck.

4. Finger-stroking manipulation is comparatively light and quick, while

the palm-rubbing is strong and slow.
【Cautions】

1. Such manipulation should be done lightly and slowly.

2. Clockwise stroking is suitable for treating deficiency syndrome, while

anti-clockwise stroking is suitable for treating excess syndrome.

3. Ointments are often used to enhance the effect of the manipulation.

4. Differentiate between kneading manipulation and stroking

manipulation. When operating kneading, fingers and palms should
fixate on a certain part of the body surface to make subcutaneous
tissues (stronger force). While operating stroking, fingers and palms
make a circular stroking with light force on the body surface without
moving subcutaneous tissues.

5. In clinical operation, the two manipulations are often used together

 Ca Fa (To-and-fro rubbing manipulation)

-exert force on the affected area with the major thenar,

palm base or minor thenar to perform straight to-and-fro
rubbing movement.
-the warm effect induced by rubbing can penetrate into the
deep layer through the body surface.

【Methods】

1. Zhang Ca Fa (To-and fro rubbing manipulation with palm)

• Keep the palm close to the skin while straightening the wrist joint
• Take the shoulder joint as pivot, and move the upper arm initiatively
with the palm rubbing on the body surface to-and-fro along a straight
line
• The frequency is 100-120 times per minute

 Suitable applied on the chest and abdomen

2. Da Yu Ji Ca Fa (To-and fro rubbing manipulation with major
thenar)

• Keep the major thenar close to the skin while straightening the wrist
joint
• Take the shoulder joint as pivot, and move the upper arm initiatively
with the major thenar rubbing on the body surface to-and-fro along a
straight line
• The frequency is 100-120 times per minute

 Operate on chest, abdomen, back, lumbar and extremities

3. Xiao Yu Ji Ca Fa (To-and fro rubbing manipulation
with minor thenar)

• Keep the minor thenar close to the skin while

straightening the wrist joint
• Take the shoulder joint as pivot, and move the upper arm
initiatively with the minor thenar rubbing on the body
surface to-and-fro along a straight line
• The frequency is 100-120 times per minute

 Operate on shoulders, back, lumbar, butt, and lower

extremities
【Essentials for performing
manipulations】
1. The rubbing route is better straight and long. The distance of rubbing should be
lengthened without deflecting or halting.

2. The palm should be kept close to the affected area.

3. The pressing force should be monitor not to make the skin folded. The frequency
should be kept even.

【Cautions】

1. To-and-fro rubbing manipulation can produce soft and warm stimulation.

2. Palm- mild warming effect; Major thenar- moderate warming effect; Minor
thenar- high heat effect.

3. Lubricants is often used to protect and lead the warmth deeply into the skin.

4. Better to apply other manipulations in order not to cause skin lesion.

 Tui Fa (Pushing manipulation)

-exert force on the affected or a certain Acupoint with

fingers, palm or other parts of the body, and make
rectilinear or arc movement.

【Methods】

1. Ping Tui Fa (Flat pushing manipulation)

(a) Mu Zhi Ping Tui Fa (Flat pushing manipulation with thumb)

• Keep the thumb close to the body surface and support with other fingers
• Flex and extend the elbow to bring the thumb to push slowly in a one
way direction along the meridian or muscular fiber
• Repeat the manipulation 5-15 times continuously
1. Ping Tui Fa (Flat pushing manipulation)

(b) Zhang Ping Tui Fa (Flat pushing manipulation with palm)

• Press on the body surface with palm and exert force with the palm base
• Flex and extend the elbow to push the palm slowly along a certain
direction
• Repeat the manipulation 5-15 times continuously

(c) Zhou Tui Fa (Flat pushing manipulation with elbow)

• Flex the elbow and exert force on certain part with the tip of the elbow
(ocleranon)
• Push slowly along the direction of muscular fiber in a straight line
2. Xuan Tui Fa (Spiral pushing
manipulation)

• Push spirally on the Acupoint with the whorl

surface of the thumb
• The frequency is about 200-240 times per
minute

3. Fen Tui Fa (Parting pushing

manipulation)

• Keep close to the body surface with the whorl

surface of two thumbs or palms
• Push from the center part to the left or right
side respectively in a direction
• The frequency is 120 times per minute
【Essentials for performing
manipulations】
1. Can exert stronger force in flat pushing manipulation. The force should be
steady, the pushing speed should be slow and the movement should be done
unilaterally.

2. When performing spiral pushing manipulation, the joints of elbow and wrist
should be kept relaxed. The thumb moves in a circle within a small range.

3. When performing separate pushing manipulation, the force of the two hands
should be even. The movement should be mild and coordinate. Then pushing
can be in a straight line or in a curved line.
【Cautions】

1. When performing pushing manipulation, the movement should be done

along a straight line or a curved line unilaterally. To-and-fro should be
avoided

2. The operating part should keep close to the body surface. The force
used should be steady, even and moderate.

3. Ointment can be used when operating the manipulation.

 Mo Fa (Wiping manipulation)

-keep close to the skin with the whorl surface of the thumb
and push up and down or left to right or along a curved
path.

【Methods】

1. Zhi Mo Fa (Finger wiping manipulation)

• Exert force on body surface with the whorl

surface of one thumb or two thumbs and
support with the rest four fingers
• The thumbs moves to and fro slowly
unilaterally up and down or left to right or
curved line
2. Zhang Mo Fa (Palm wiping manipulation)

• Exert force on the body surface with one or two palms and
relax the wrist joint
• The forearm and upper arm exert force coordinately to
move the palm to and fro slowly unilaterally up and down
or left to right or a curved line
【Essentials for performing
manipulations】
1. When performing wiping manipulation, the whorl surface of the thumb or the
palm should be kept close to the body surface.

2. The force used in wiping manipulation should be even, while the movement should
be mild and slow. The operation route in the affected area should be longer

3. The manipulation should be light but not superficial, heavy but not stuck

【Cautions】

1. The stimulation of wiping manipulation is superficial.

2. Wiping manipulation is easily confused with pushing manipulation. The

movement pushing is done unilaterally, while the movement of wiping can be
done up and down, or in a straight line or in a curved line, appearing more
flexible.

3. When finger wiping is applied to the head and face, the performing procedure is
fixed.
 Cuo Fa (Palm-twisting manipulation)

-clip a certain part of the body or extremity with both

palms, and perform swiftly or alternately twisting and
kneading to-and-fro with opposite force.

【Methods】

1. Cuo Fa (Palm-twisting manipulation)

• The patient is in a sitting position with relaxed and

naturally dropped shoulders and arms
• The practitioner stands by the patient’s shoulder
with two palms, performing swift twisting and
kneading movement with opposite force
• And at the same time moving up and down from the
upper extremity to the wrist 3-5 times
【Essentials for performing
manipulations】
1. While performing palm-twisting manipulation, the exertion of force should be
symmetric and mild.

2. The patient should keep the extremities relaxed.

3. The operation demands “rapid twisting and slow moving”. The twisting
movement should be swift while the up and down moving should be slow.

【Cautions】

1. While in performing palm-twisting manipulation, the force should not be too

heavy.

2. Avoid tight clip in order not to cause the manipulation stuck.

3. It is a supplementary manipulation. Mostly applied to shoulders and upper

extremities.
 Zhen Fa (Vibrating manipulation)

-perform by pressing a certain Acupoint or part of the body

with finger or palm, and vibrating swiftly and
continuously.

【Methods】

1. Zhi Zhen Fa (Finger-vibrating manipulation)

• Drop the elbow and put the tip of the middle finger on the
affected area
• Straightening the finger and flex the elbow slightly with
forearm and hand
• And contract the muscles alternatively to direct the
vibration produced by arm to the body through the middle
finger
• The frequency of vibration is 300-400times per minute
2. Zhang Zhen Fa (Palm-vibrating manipulation)

• Stretch the wrist joint slightly backwards and extend the

finger naturally
• Press the patient’s body gently with the palm and flex the
elbow slightly
• Exert force statically with forearm and hand, and contract
the muscles alternatively to direct the vibration produced
by the arm to the body through the palm
• The frequency of vibration is 300-400times per minute
【Essentials for performing
manipulations】
1. While performing finger vibrating and palm vibrating, the shoulder joint should
be abducted for about 30°, and the elbow joint should be flexed about 140°.

2. Exerting force statically means to tighten the muscles of the hand and forearm.

3. The practitioner should highly concentrate his attention on the finger and palm.

【Cautions】

1. While in performing vibrating manipulation, the muscle should exert force

while keeping static. Practitioner should breathe normally and avoid holding
his breath.

2. Vibrating manipulation consumes more strength. Long term training are

necessary to achieve better effect.
 Dou Fa (Shaking manipulation)

-hold the distal end of the patient’s affected extremities

with one hand or both hands to shake constantly up and
down or from the left to the right in a small amplitude.

【Methods】

1. Dou Fa (Shaking manipulation)

• Hold the distal end of the patient’s upper or lower

extremities (wrist or ankle)
• Lift the treated limb to a certain angle (upper-sitting:60°;
lower-supination:30°)
• When pulling with slight force, shake constantly up and
down in a small amplitude to cause the parenchyma of the
affected limb to shake and transmit to the proximal end of
the extremities
【Essentials for performing
manipulations】
1. The shaken extremities should be kept relaxed and straightened naturally.

2. The practitioner should be breathe normally and avoid holding breath.

3. The amplitude of shaking should be small and the frequency should be rapid.

【Cautions】

1. When shaking the lower extremities, the amplitude of shaking can be wider
than upper extremities.

2. The frequency should be lower for the lower extremities which are heavier.

3. Shaking manipulation is often used as s finishing manipulation

 An Fa (Point-pressing manipulation)

-press a certain Acupoint or part of the body surface with

finger or palm and exert force gradually.

【Methods】

1. Zhi An Fa (Finger pressing manipulation)

• Straighten the thumb and press the meridian on the body

surface with the tip or whorl surface of the thumb,
supported by other four fingers
• If the force of one thumb is not enough, the other thumb can
be overlapped on it and press downward heavily with the
thumb face
2. Zhang An Fa (Palm pressing manipulation)

• Press the body surface with palm base, thenar or the whorl
palm
• If the force of one hand is not enough, both hands can be
overlapped to press
【Essentials for performing
manipulations】
1. The direction of pressing should be vertical.

2. The force use should be steady and continuous, and be increased steadily to
make the stimulation transmit sufficiently to the deep layer of the body tissues.
“light-heavy-light”

3. When performing pressing manipulation, the practitioner can incline his upper
part of the body slightly forwards to increase the stimulation with his own
gravity
【Cautions】

1. Sudden violent force should be avoided lest side effect be caused.

2. Pressing manipulation is marked by change rhythm. Attention should be paid

to the difference between continuous pressure and pressing manipulation.

3. Pressing and kneading is used together in clinical. (Press-kneading

manipulation)
 Ya Fa (Suppressing manipulation)

-fix the thumb, palm or olceranon of the elbow joint on a

certain Acupoint or part of the body surface and press
downwards continuously.

【Methods】

1. Ya Fa (Suppressing manipulation)

• Suppress the body surface vertically with the whorl surface

of the thumb, palm or the elbow joint (olceranon)
• While suppressing with the upper part of the forearm of the
elbow is called elbow suppressing manipulation
【Essentials for performing
manipulations】
1. Pressing manipulation is similar to suppressing manipulation, simply called
“pressing”

2. The former is more dynamic while the latter is static.

3. The duration of pressing manipulation is short while the duration of

suppressing is longer

4. The force of pressing is light with small stimulation while the force of suppress
is strong with great stimulation

【Cautions】

1. Control a moderate force when suppressing on a dorsolumbar region as to avoid

side effect.

2. Elbow suppressing is often applied to the muscles of waist and buttock for those
who are strong.
 Nie Fa (Pinching manipulation)

-exert force symmetrically with the thumb and the other

fingers to extrude the operated part.

【Methods】

1. Nie Fa (Pinching manipulation)

• Clip the operated part with the thumb and the index finger,
middle finger or with the thumb and the other four fingers
• Extrude symmetrically and release immediately after that
• Repeat the manipulation mentioned above the move
gradually
【Essentials for performing
manipulations】
1. The force should be exerted with the thumb and the other fingers should be
symmetrical, even and soft.

2. The movement should be continuous and rhythmical

【Cautions】

1. The force should be exerted with the palm, not the tip of the finger.

2. When performing pinching manipulation, much attention should be paid to the

force of the finger, esp, the combination force between the thumb and the other
four fingers
 Na Fa (Grasping manipulation)

-exert force symmetrically with the thumb and the other

four fingers to lift, pinch or clip the extremities or the skin.

【Methods】

1. Na Fa (Grasping manipulation)

• Relax the wrist joint and clip the operated part tightly with
the thumb, index finger and middle finger or with the thumb
and the whorl surface of the other four fingers
• Lift the skin and repeat the performance of kneading and
pinching continuously and alternatively in a form of forceful
and gentle way
【Essentials for performing
manipulations】
1. Relax the wrist joint and straighten the fingers.

2. Clip the operated part with the fingers and exert force symmetrically to lift and
pinch the skin and the subcutaneous tissues.

3. Perform the manipulation slowly, softly and evenly, fluctuating from the light to
heavy, then heavy to light. (kneading and pinching together)

【Cautions】

1. When performing grasping manipulation, cautions should be taken not to clip the
epidermis to avoid flexion of interphalangeal joints.

2. Subcutaneous tissues should be pinched. The slippage of the fingers on the body
surface should be avoided.

3. Kneading and rubbing can be used after grasping to smooth Qi and blood
 Nian Fa (Finger-twisting manipulation)

-hold the operated part with the thumb and the index
finger, and twist while kneading and pinching
symmetrically.

【Methods】

1. Nie Fa (Finger-twisting manipulation)

• Exert force symmetrically and hold the operated part with

the whorl surface of the thumb and the radial border of the
index finger
• Then make a quicker twisting with force like twisting a
thread
【Essentials for performing
manipulations】
1. When performing finger-twisting manipulation, the movement should be
continuous, dexterous, soft and trenchant.

2. The frequency of finger-twisting should be quicker, while the movement from up

to down on operated part should be slower

【Cautions】

1. Finger-twisting manipulation should be a

supplementary manipulation which is commonly
applied to joints of fingers and toes.
 Bo Fa (Plucking manipulation)

-press the operated part deeply with the thumb, and pluck
back and forth. The direction of the movement should be
perpendicular to the direction of the tendon and muscle.

【Methods】

1. Bo Fa (Plucking manipulation)

• Extend the thumb, exert the force with the tip or the whorl
surface of the thumb, and support with the other four
fingers.
• Press deeply until the patient feels aching and distending
• Then pluck back and forth along the direction perpendicular
to the direction of the tendon and muscle
• If the strength of one thumb is not enough, two thumbs can
be overlapped
 【Essentials for performing
manipulations】
1. When performing plucking manipulation, the thumb should
not rub and move on the body surface, but direct the
subcutaneous muscular fiber or tendon and ligament to pluck
together

2. When performing plucking manipulation, the force used

should be increased gradually.

【Cautions】

1. Plucking manipulation is often performed on

tenderness.

2. The stimulation of plucking is strong. Kneading

and rubbing manipulations can be used after
plucking to smooth Qi and blood.
 Pai Fa (Patting manipulation)

-pat on the body surface rhythmically with an empty palm.

【Methods】

1. Pai Fa (Patting manipulation)

• Coalesce the fingers and slightly flex the

metacarpophalangeal joints so as to form an empty palm
• Then pat the operated part rhythmically
• The frequency is 100-120 times per minute
 【Essentials for performing
manipulations】
1. While performing patting manipulation, the shoulder joint should be dropped
and the wrist should be kept relaxed.

2. The patting should be springy and steady. Can be performed by one or two
hands.

3. The palm should bounce up right away after patting on the operated part. The
movement should be done in rhythm.

【Cautions】

1. The palm should pat on the body surface flatly. Any dragging and whipping
movement on the body surface should be avoided.

2. Patting should not go beyond the desirable state that the skin appears
reddish and congested.

3. It is prohibited to apply to the patient who suffers from tuberculosis,

serious osteoporosis, bone tumor or heart disease.
 Ji Fa (Hitting manipulation)

-hit the operated part rhythmically with the palm base,

the minor thenar, the back of a fist, the finger tip or a
mulberry stick.

【Methods】

1. Zhang Gen Ji Fa (Hitting manipulation the palm base)

• Hit the body surface with the palm base while stretching the
fingers naturally and stretching the wrist joint slightly
backward
2. Ce Ji Fa (Hitting manipulation with the
lateral side of palm)

• Hit the body surface with the minor thenar of

both palms alternately while stretching the
fingers naturally and the wrist joint slightly
backward

3. Quan Ji Fa (Hitting manipulation with a

fist)

• Hit the body surface with the dorsum of the

fist
• The frequency is 3-5 times every time
4. Zhi Jian Ji Fa (Hitting manipulation
with finger tips)

• Hit the treated part with the tips of the

fingers closing up like a plum blossom or a
open claw
【Essentials for performing
manipulations】
1. The exertion of force in hitting manipulation should be rapid with a short duration.
The hitting on the body surface should be vertical. Even in rhythm.

2. When performing hitting with palm base, use the palm base as the force exerting
point and strike with the force from the forearm. With greater amplitude and 3-5
times.

3. Hitting with lateral side of palm can be performed with one hand or both hands
holding together. The minor thenar should be vertical with the direction of the
muscular fiber, and rapid with rhythm.

4. When performing fit hitting, the elbow joint is taken as the pivot. Make use of the
force from the flexion and stretch the elbow joint and forearm to strike.

5. When performing finger-tips hitting, relax the wrist joint and flex the elbow joint
in a small amplitude. Tap the body surface with the tip of the finger at a rapid
speed like rain drops.
【Cautions】

1. When hitting, attention should be paid to bouncing. Any halting, dragging

or whipping should be avoided.

2. Strictly follow the indications of different hitting manipulation, violent

striking should be avoided.

3. Fist hitting is applied to Dazhui (GV14) and the lumbar region; palm
hitting is applied to Baihui (GV20) and Huantiao (GB30); finger-tips hitting
is applied to the head;
 Tan Fa (Flipping manipulation)

-press the back of the index tightly with the middle finger
and spring rapidly to flip a certain part or Acupoint.

【Methods】

1. Tan Fa (Flipping manipulation)

• Flex the index finger and press the back of the index finger
tightly with whorl surface of the middle finger
• Then spring rapidly to hit the treated part
• The frequency is about 120-160 times per minute
 【Essentials for performing
manipulations】
1. The manipulation should be performed evenly and continuously.

2. The intensity of stimulation should be carefully monitored to avoid pain.

【Cautions】

1. It is often used as a supplementary

manipulation applied to the head and
face.
 Yao Fa (Rotating manipulation)

-it is a passive movement performed within the range of the

joint or semi-joint.

【Methods】

1. Jing Bu Yao Fa (Neck-rotating manipulation)

• The patient takes a sitting position with the neck relaxed

• The doctor stands on the side of the patient, holds the
patient’s head posterior to vertex with one hand, and holds
the lower jaw with the other hand
• Then rotate the head clockwise and anti-clockwise slowly for
several times respectively with both hands giving force in
opposite direction
2. Jian Bu Yao Fa (Shoulder-rotating manipulation)

a) Tuo Zhou Yao Jian Fa (Shoulder-rotating

manipulation by supporting the elbow)
• The patient relaxes his shoulder and flexes his elbow
• The doctor stands by the side of the patient, standing in an
bow-like pose with the upper body inclining forward slightly
• Holding the upper part of the patient’s shoulder blade with
one hand to fix it, and the affected elbow with the other
hand
• Rotating clockwise or anti-clockwise for several times

b) Wo Wan Yao Jian Fa (Shoulder-rotating

manipulation by holding the elbow)
• The patient relaxes his shoulder with the upper extremities
lowering naturally
• The doctor holds the upper part of the patient’s shoulder
blade with one hand, and the affected elbow with the other
hand
• Then rotating clockwise or anti-clockwise for several times
c) Da Fu Du Yao Jian Fa (Shoulder-rotating
manipulation in great amplitude)

• The patient lowers his upper extremities naturally

• The doctor stands by the side of the patient in a T-shaped
stance, holding the patient’s wrist with one hand and
supporting the patient’s forearm with the dorsum of the
other hand
• The doctor turns the dorsum of his hand and raises the
patient’s wrist when lifting the patient’s upper extremity to
160° with the other hand slipping down to support the
patient’s shoulder
• After a pause, the doctor uses both hands to rotate the
affected extremity backward in a great amplitude
• If the direction of rotation is opposite, then the manipulation
is also performed in the opposite way
3. Zhou Bu Yao Fa (Elbow-rotating manipulation)

• The patient takes a sitting position or supine position

• The doctor holds the affected elbow with one hand, and holds
the affected wrist with the other to rotate the elbow joint
clockwise and anti-clockwise for several times

4. Wan Bu Yao Fa (Wrist-rotating

manipulation)

• The doctors holds the upper end of the

affected wrist joint of the patient with one
hand and the palm with the other
• Rotating the wrist joint clockwise and anti-
clockwise for several times respectively
while pulling and extending the wrist joint
5. Yao Bu Yao Fa (Waist-rotating manipulation)

a) Sitting position with waist relaxed

• The doctor stands behind the patient with one hand holding
one side of the patient’s waist and the other hand suporting
the shoulder on the other side
• Bending upper part of the patient’s body in all directions
with the force of both hands to rotate the waist clockwise
and anti-clockwise for several times

b) Supine position with knee and hip flexed

• The doctor presses the knees of the patient with one hand to
make them coalescent
• And holds the lower part of the patient’s calves or two
ankles with the other hand
• Then rotating the lower extremities to move the waist
clockwise and anti-clockwise for several times
6. Kuan Bu Yao Fa (Hip-rotating manipulation)

• The patient takes a supine position with the affected hip

and knee flexed and the healthy side of the extremity
stretched straightly
• The doctor stands beside the patient, supports the
patient’s knee with one hand and holds his heel with the
other hand, flexing the patient’s hip joint for 90° with the
force of both hands to rotate the hip joint clockwise and
anti-clockwise
7. Xi Bu Yao Fa (Knee-rotating manipulation)

• The patient takes a supine position with the affected knee

and hip flexed
• The doctor supports the upper part of the knee to fix it with
one hand, and holds the heel with the other hand to rotate
the knee joint clockwise and anti-clockwise.

8. Huai Bu Yao Fa (Ankle-rotating manipulation)

• The patient takes a supine position with the extremity

stretching naturally
• The doctor stands behind his foot and holds the lower part of
his calf with one hand, and holds the foreside of the instep
with the other hand to rotate the ankle joint clockwise and
anti-clockwise.
【Essentials for performing
manipulations】
1. Movement of rotating manipulation should be moderate and mild with steady
force.

2. The frequency should be slow and even, esp in the beginning.

3. The amplitude of the rotations should be gradually increased and adjusted

according to individual conditions. Keep within normal physical joint movement.

【Cautions】

1. Rotating should not be done violently or violate the movement of normal

physical activity. Manipulation should be adjusted if any dysfunction of the
joint

2. Rotating is forbidden to treat patients with fracture or dislocation of joint.

Neck-rotating is not allowed to be used to treat patients with vertebral artery
type of cervical spondylosis. For patients with excessive stiffness of cervical
muscles, supine position is advisable.
 Ba Shen Fa (Pulling-extending manipulation)

-Fixate one end of a joint or an extremity, pull and extend

the other end with constant force to enlarge the joint space.

【Methods】

1. Jing Bu Ba Shen Fa (Pulling-extending manipulation of the

neck)

a) Zhang Zhi Tuo Jing Ba Shen Fa (Pulling-extending

manipulation with palm and finger supporting the neck )
• The patient takes a sitting position and the doctor stands behind him
• The doctor supports the inferior aspect, Fengchi (GB20), of the
patient’s occipital bone with his thumbs,
• Holds the inferior aspect of the angles of the lower jaws and puts both
of his forearms on the patient’s shoulders
• Holding the patient’s head up with both hands and pressing the
patient’s shoulders down at the same time, to pull and extend the
b) Zhou Bu Tuo Jing Ba Shen Fa (Pulling-extending
manipulation with elbow supporting the neck )
• The patients takes a sitting position with the head inclining slightly
forward
• The doctor stands behind the patient, holds the patient’s chin with
one hand crossing from the front part of the patient’s neck
• Holding the patient’s occiput with the part between the thumb and
the four fingers of the other hand
• Then pulling the extending the neck up slowly along the direction of
longitudinal axis of the cervical vertebrae with both hands
simultaneously

b) Yang Wo Wei Ba Shen Fa (Pulling-extending

manipulation in supine position)
• The patients takes a supine position
• The doctor sits at the front of the patient’s head with
one hand holding the patient’s occiput and the other
holding the patient’s chin
• Then pulling and extending the neck along the
direction of longitudinal axis of the cervical vertebrae
with both hands simultaneously
2. Jian Bu Ba Shen Fa (Pulling-extending
manipulation of the shoulder)

a) Shang Ju Ba Shen Fa (Up-lifting pulling-extending

manipulation)
• The patient sits on a stool with the affected extremity
relaxed
• The doctors stands behind, holds the patient’s wrist with
both hands and lift it up gradually to the maximum limit
• Pulling constantly around the longitudinal axis of the
upper extremity in order to pull and extend the shoulder

b) Wai Zhan Ba Shen Fa (Pulling-extending

manipulation by abduction)
• The patient takes a sitting position with the relaxed
affected extremity abducting for 45-60°
• The assistant stands by the healthy side holding the
patient’s body from the subaxillary regions to fix it with
both hands
• The doctor holds wrist of the affected side with both hands
and pulls gradually around the longitudinal axis of the
upper extremity
3. Zhou Bu Ba Shen Fa (Pulling-extending
manipulation of the elbow)

• The patient takes a sitting position

• The doctor fixes the proximal end of the elbow joint of the
affected extremity with one hand (or with the help of the
assistant)
• Holds the distal end of the forearm with the other hand
• Then pulling and extending the elbow joint with both
hands from opposite direction

4. Wan Bu Ba Shen Fa (Pulling-extending

manipulation of the wrist)

• The patient takes a sitting position

• The doctor holds the proximal end of the wrist of the
affected extremity with one hand
• And holds the patient’s palm and fingers with the other
hand
• Then pulling and extending the wrist from opposite
direction
5. Shou Zhi Ba Shen Fa (Pulling-extending
manipulation of the fingers)

• The doctor holds the wrist of the affected finger with one
hand
• And fixes the affected finger between the flexed index and
middle fingers
• Then pulling and extending from opposite direction

6. Yao Bu Ba Shen Fa (Pulling-extending

manipulation of the waist)

• The patient takes a prone position

• Ask the patient to hold the edge of the bed with both
hands
• The doctor stands behind and holds the patient’s ankles
with both hands, and pulling back constantly with gradual
force
7. Xi Bu Ba Shen Fa (Pulling-extending manipulation of the knee)

• The patient takes a prone position with the knee of the affected side flexed for 90°
• The doctor stands by the affected side and presses the lower part of the backside
of the affected thigh with one knee
• Holds the ankle with both hands, then pulling and extending the knee joint up
around the longitudinal axis of the calf

8. Huai Bu Ba Shen Fa (Pulling-extending manipulation of the ankle)

• The patient takes a supine position

• The doctor holds the heel of the affected foot with one hand
• And hold the toes with the other hand
• Then pulling the ankle around the longitudinal axis of the shin
【Essentials for performing
manipulations】
1. The performance of pulling-extending manipulation should be done stably and
gently with the strength intensified gradually.

2. When traction reaches a certain degree, it should be kept steady for a while

3. The angle of traction should be well adjusted and the pulling should be done
around the longitudinal axis of the extremity

【Cautions】

1. Violent force and action against the direction of the physiological activities
should be avoided

2. When performing the pulling-extending manipulation of the neck, cares should

be taken to avoid the carotid sinus on both sides of the neck
 Ban Fa (Pulling manipulation)

-this manipulation means to pull to the same direction or opposite

direction with both hands to extend, flex or rotate the affected joints. it is
a commonly used manipulation and there are different methods for
performing on the neck, waist or extremities.

【Methods】

1. Jing Bu Ban Fa (Pulling manipulation of the neck)

a) Jing Bu Xie Ban Fa (Manipulation for obliquely-pulling the

neck)
• The patient takes a sitting position with the head slightly bent
forward
• The doctor stands behind the patient, holds the patient’s head at the
occiput with one hand and the chin with the other
• Then rotating the patient’s head to the left or right
• When the head is turned to the restricted side where there is an
elastic resistance, rotation should be stopped
• Then do a quick and controlled pulling in a small amplitude
b) Jing Zhui Xuan Zhuan Ding Wei Ban Fa (Pulling
manipulation for rotating and locating cervical
vertebrae)

• The patient takes a sitting position with his head flexed

forward for 15-30 degrees
• Take pulling and rotating to the left side for example: the
doctor stands behind the patient’s left side while pressing the
lateral side of the spinal process of the patient’s affected
cervical vertebrae with the right thumb
• Holding the chin with the left hand (elbow fixate the chin) to
fix the patient’s head while rotating slowly to the left side till
there is an elastic resistance
• The stopping rotation for a moment and taking a quick and
controlled pulling action along the direction of the rotation
within a small amplitude
• The thumb pressing the spinal process pushes and presses
towards the opposite side
• Cracking sound is often heard if reduction of the joint is
successful

 The doctor can feel a flick under his thumb even there is no
cracking sound
2. Xiong Zhui Ban Fa (Pulling manipulation of the thoracic
vertebrae)

a) Xiong Zhui Dui Kang Fu Wei Fa (Counter-reduction

manipulation of the thoracic Vertebrae)

• The patient takes a sitting position with his fingers crossed behind
the occiput
• The doctor stands behind the patient with one foot stepping on the
chair on which the patient sits,
• And put his knee against the patient’s spinal process of the thoracic
vertebrae
• Stretching both hands between the upper arm and the forearm from
the patient’s armpits
• Holding the lower part of the forearm, pressing the patient’s forearm
with both hands and raising his forearm to bend the patient’s neck
slightly
• At the same time, the doctor pulls the spine backward and upward
• Pausing for a while, the doctor’s both hands and arms exert force to
take a quick and controlled pulling action within a small amplitude,
then sustain his knee suddenly
• Cracking sound is often heard during such an action
2. Xiong Zhui Ban Fa (Pulling manipulation of the thoracic
vertebrae)

b) Xiong Zhui An Ya Fu Wei Fa (Pressing reduction of thoracic

Vertebrae)

• The patient takes a prone position

• The doctor folds his arms and puts pisiform bone of the palm base on
the transverse process of the vertebra
• Asking the patient to breathe deeply
• When the patient is exhaling, the doctor exerts force suddenly with
the elbow joint to press
• Cracking sound is often heard
3. Yao Bu Ban Fa (Pulling manipulation of the waist)

a) Yao Zhui Xie Ban Fa (Obliquely pulling manipulation of the

lumbar vertebrae)

• The patients takes a lateral position with the healthy leg below
straightening naturally
• The affected leg flexes at the hip joint, its ankle is put on the
popliteal fossa of the healthy leg
• The doctor faces the patient, and puts both elbows on the patient’s
front part of the forearm and hip
• Then exerting opposite force slowly to pull the waist, and taking a
quick and controlled pulling action within a small amplitude
• Cracking sound is often heard during such manipulation
b) Yao Bu Hou Shen Ban Fa (Pulling manipulation of the waist)

• The patient takes a prone position

• The doctor stands beside the patient and presses the patient’s waist
with one hand and holds the affected extremity
• Extending the lumbar vertebrae backward to take a quick and
controlled backward pulling within a small amplitude
4. Jian Bu Ban Fa (Pulling manipulation of the
shoulder)

a) Jian Shang Ju Ban Fa (Pulling manipulation for

uplifting the shoulder)

• The patient takes a sitting position with both arms

dropping naturally
• The doctor stands behind the patient, fixes the patient’s
trunk with his body
• holding the lower end of the affected forearm with one
hand and raising slowly from the anterior flexion to 120-
140degrees
• The other hand holds the part near the wrist joint of the
forearm, pulling upward gradually with both hands
• Then take a quick controlled upward pulling action within
a small amplitude
• The manipulation can be repeated for 3-5 times
b) Jian Nei Shou Ban Fa (Pulling manipulation for
adducting the shoulder)

• The patient takes a sitting position and keeps the affected

extremity flexed before the chest
• The doctor stands close to the patient’s back, flexes the
affected shoulder with one hand,
• And holds the affected elbow with the other hand to pull
inward
• then taking a quick and controlled adducted pulling action
within a small amplitude
• The manipulation can be repeated for 3-5 times
c) Jian Hou Shen (Nei Xuan) Ban Fa (Pulling
manipulation for backward extending or adducting
the shoulder)

• The patient takes a sitting position with the affected

extremity dropping naturally
• The doctor stands behind the side of the patient to fix the
affected shoulder with one hand
• Holds the wrist of the affected arm with the other hand
• Extending the affected arm backward and flexing the
elbow with the back of the hand closing to the back
• Then taking a quick and controlled upward pulling action
within a small amplitude
• The manipulation can be repeated for 3-5 times
5. Zhou Bu Ban Fa (Pulling manipulation of the elbow)

• The patient takes a supine position

• The doctor holds the lower end of the patient’s upper arm with one hand,
and holds the lower end of the forearm with the other
• Flexing and stretching the elbow joint repeatedly, then taking a
controlled flexing, stretching and pulling action within a small amplitude
• The manipulation can be repeated for 3-5 times

6. Wan Bu Ban Fa (Pulling manipulation of the wrist)

• The doctor holds the lower end of the patient’s forearm to fix with one
hand
• And holds the patient’s palm to pull with the other hand
• Then flexing and stretching the wrist joint, followed by a controlled
flexing or stretched pulling action within a small amplitude
7. Di Qia Guan Jie Ban Fa (Pulling manipulation of sacro-iliac
articulation)
(Backward extending and pulling manipulation of sacro-iliac
articulation)

• The patient takes a prone position

• The doctor stands by the healthy side of the patient, presses the posterior
and superior iliac spine with the palm base of one hand
• Holds the lower part of the affected thigh with the other hand
• Flexing the knee joint of the affected side and extending the affected leg
backward
• Then the patient is asked to cough, the doctor takes a sudden controlled of
the lower extremity to 3-5 degrees
• And quickly pressing the posterior superior iliac spine
8. Xi Guan Jie Ban Fa (Pulling manipulation of the knee joint)
(Pulling manipulation for extending knee joint)

• The patient takes a supine position

• The doctor stands at the side of the patient, pressed the knee of the
affected leg with one hand
• Puts the other arm at the posterior side of the lower part of the
affected calf
• Exerting force with both hands to stretch the knee, and then taking
quick controlled pulling action within a small amplitude

9. Huai Bu Ban Fa (Pulling manipulation of the ankle)

• The patient takes a supine position

• The doctor holds the patient’s heel with one hand and holds the toes
with the other hands
• Flexing and stretching the ankle joint or turning the ankle joint
outward or inward
• Then take a quick controlled pulling action within a small amplitude
【Essentials for performing
manipulations】
1. When performing pulling manipulation, it should be performed within the limit
of the physiological movement of the joints.

2. Turning the joint to the limited degree is a critical step for successful
performance of the manipulation

3. The performance of the pulling manipulation should be quick and mild.

4. The patient should keep relaxed as much as possible. Manipulating with the
patient’s inhale and exhale exercise.

【Cautions】

1. Strength should be controlled properly. Violent action should be avoided.

2. The amplitude of pulling should be monitored within normal physiological

movement of the joints.

3. Never try to achieve cracking sound on purposefully lest injury be caused

4. Pulling manipulation should not be used to treat joint fracture or dislocation of

joint.