Dao Yin (导引) is a health-preserving practice primarily based on physical movements combined with breathing techniques, originating from ancient dance movements. During the Spring and Autumn and Warring States periods, Dao Yin techniques saw significant development, leading to the emergence of styles such as ‘Xiong Jing’ (熊经) and ‘Niao Shen’ (鸟伸). The discovery of over 40 poses in the ‘Dao Yin Tu’ (导引图) from the Mawangdui Han tomb No. 3 summarizes the pre-Qin Dao Yin techniques. Early Dao Yin also included Qigong and massage, which gradually separated from Dao Yin after the Sui and Tang dynasties.As a unique health-preserving method, Dao Yin has developed through the ages, with representative schools such as the ‘Chi Song Zi Dao Yin Fa’ (赤松子导引法) created by Prince Qiao of the Zhou dynasty, the ‘Jian Zhen Tu Na Shu’ (鉴真吐纳术) developed by the monk Jian Zhen during the Tang dynasty, the ‘Guang Du Dao Yin Shu’ (广渡导引术) initiated by the monk Guang Du in the Song dynasty, and the ‘Lao Ren Dao Yin Fa’ (老人导引法) established by Cao Tingdong in the Qing dynasty.Dao Yin was first mentioned in the ‘Zhuangzi’ (庄子). In the chapter ‘Ke Yi’, it states: ‘Blow and breathe, exhale the old and inhale the new, Xiong Jing and Niao Shen, for longevity. This is the way of Dao Yin practitioners, nurturing the body and spirit, favored by Peng Zu (彭祖) for longevity.’ Chen Yuanying’s commentary interprets ‘Dao Yin’ as ‘guiding the spirit and qi to nourish the body and soul, the way to prolong life and maintain the body.’ In ‘Su Wen’ (素问), it states: ‘The central region is flat and moist, where heaven and earth give birth to all things. Its people eat a mixed diet without labor, hence they suffer from many diseases like atrophy and cold heat; thus, treatment should involve Dao Yin and massage, which also originates from the central region.’ Wang Bing’s commentary explains: ‘Dao Yin means to shake the muscles and bones, move the joints, while ‘an’ refers to pressing the skin and flesh, and ‘tui’ means to lift the hands and feet.’ Dao Yin also includes acupressure techniques, tooth tapping, gurgling with saliva, beating the sky drum, dry combing the hair, dry washing the face, rubbing the ears and eyes, massaging the soles of the feet, and self-massaging the kidneys, among others. It is often combined with breath control and mindfulness to form a series of practices.In 1984, the oldest known medical Dao Yin text, ‘Yin Shu’ (引书), was discovered in bamboo slips unearthed in Zhangjiashan, Hubei. ‘Yin Shu’ is the most comprehensive ancient book documenting Dao Yin techniques before the Qin and Han dynasties. Research on the Dao Yin techniques mentioned in ‘Yin Shu’ found that it includes several articles related to pain, clearly identifying five specific pain locations, one of which is ‘Yin Xi Tong’ (引膝痛) or ‘Knee Pain’.‘Yin Xi Tong’ specifically provides guidance for knee joint pain. The method is simply described as: supporting oneself with one hand on a stable point, with one leg supporting the body while the other leg swings back and forth a thousand times, alternating sides, which can be completed several times throughout the day. The method is simple and easy to learn.What is the rationale behind swinging the hip joint to treat knee joint pain?Directly exercising the knee joint may exacerbate pain; however, swinging the hip joint indirectly stretches the tendons and ligaments around the knee joint, activating the entire system. A program on Chinese medicine aired on CCTV introduced this method: CCTV Video. In the video, Dr. Luo Congfeng explained the principle using Western medicine. There are many tendon and ligament attachment points around the knee joint, with the other ends attached to the hip joint and pelvis. Swinging the hip joint pulls on the tendons and ligaments around the knee joint, increasing the flow of synovial fluid in the knee, enhancing cartilage regeneration, thereby improving knee function and alleviating pain. Additionally, some theories suggest that this method opens the gap in the knee joint, reducing cartilage friction and relaxing the stiff muscles and ligaments around the joint. It can also increase muscle strength.A research paper from Shandong University of Traditional Chinese Medicine detailed this method:1. Preparation of training equipment (1) The site should have a stable object that the patient can grasp at waist height, such as a radiator, stair railing, or fitness equipment in a public square; (2) A support object 15 cm above the ground, such as a stair step. 2. Requirements for the ‘Yin Xi Tong’ Dao Yin technique (1) ‘Yin Xi Tong’ Technique One Original text: ‘Yin Xi Tong, right knee pain, left hand supports, inward swing of the right foot, a thousand times; left knee pain, right hand supports, outward swing of the left foot, a thousand times.’ ① The patient stands naturally relaxed, with the affected leg as the swinging leg and the other side as the supporting leg; ② The patient stands on a support 15 cm above the ground, holding the railing with the upper limb on the supporting side, while the affected leg begins to swing naturally; ③ The height of the swing should be such that the toes do not touch the ground, and the amplitude should be as natural as possible; during the swing, the upper body should remain upright without swaying; ④ The number of repetitions and intensity should follow the requirements of the third point. (2) ‘Yin Xi Tong’ Technique Two Original text: ‘Yin Xi Tong, right knee pain, left hand supports, inward swing of the right foot, a thousand times; left knee pain, right hand supports, outward swing of the left foot, a thousand times.’ ① The patient stands naturally relaxed, with the upper limb on the affected leg side holding the railing or handrail; ② The affected leg bends backward at the knee, using the upper limb on the supporting side to hook the toes of the affected leg, then hold for 3-5 seconds; ③ Slowly lower the affected leg to complete the action; ④ Train 10 times daily. 3. Explanation of training frequency and intensity for ‘Yin Xi Tong’ ‘Yin Xi Tong, right knee pain, left hand supports, inward swing of the right foot, a thousand times; left knee pain, right hand supports, outward swing of the left foot, a thousand times. Left hand hooks the left toe, pulls it back, ten times; right hand supports, pulls the left toe, ten times.’ ‘Yin Shu’ specifies the number of repetitions for the ‘Yin Xi Tong’ technique, such as ‘a thousand times’ and ‘ten times’. In preliminary trials, it was found that patients with pain and low tolerance could not complete the ‘a thousand times’ during the first training session. Following a gradual and personalized training plan, reasonable training repetitions should be set based on individual conditions. Training repetitions: The first day’s repetitions for Technique One is 120 times, with the second day’s training increasing by 45 from the first day, and so on, until the 21st day of treatment reaches 1000 times, maintaining this number thereafter; Technique Two follows the original text with 10 repetitions daily. The total repetitions for Technique One are divided into three groups, with each group consisting of 1/3 of the total daily repetitions, allowing for 2-5 minutes of rest between groups based on the patient’s condition; Technique Two’s total is 10 repetitions daily, without grouping. Effectiveness Analysis:Some studies suggest that for patients with knee osteoarthritis, the pendulum leg swing therapy has good long-term effects in alleviating pain, improving knee flexion and extension range, and enhancing knee function, but the effects are still lacking for patients with moderate to severe knee osteoarthritis.Other studies indicate that this method can improve pain and quality of life in patients with degenerative knee arthritis, but there are certain limitations, such as short observation time and the need for long-term practice of this Dao Yin technique without long-term follow-up to observe its lasting effects.Author’s Understanding:Treating osteoarthritis is not something that can be completely cured by a single method. From traditional Chinese medicine to Western medicine, from conservative to surgical approaches, from nutrition to medication, each method has its advantages and limitations, requiring a comprehensive understanding, experimentation, selection, observation, and continuous adjustment based on individual circumstances.References and Further Reading:1.https://tv.cctv.com/2018/05/19/VIDE5Q9p0NbHfndN20NGc3Mm180519.shtml2.https://www.jianshu.com/p/6fd80c81670a3. Xu Mengting. Observation of the Efficacy of ‘Yin Xi Tong’ Dao Yin Method in Improving Pain and Quality of Life in Patients with Degenerative Knee Arthritis [D]. Shandong University of Traditional Chinese Medicine, 2020. DOI:10.27282/d.cnki.gsdzu.2020.000446.4. Ding Zhijun, Gao Lingguang, Liu Hongguang. Study on the Efficacy of Pendulum Leg Swing Therapy for Knee Osteoarthritis [J]. Chinese Journal of Geriatric Health Care, 2021, Vol. 19(6):123-125, 128.5.‘Zhangjiashan Han Slips: Yin Shu’ (张家山汉简·引书)
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