Traditional Chinese rehabilitation therapy has a long history and is flourishing. During the Spring and Autumn and Warring States periods, rehabilitation techniques such as Tui Na (推拿) and Dao Yin (导引) guided by TCM theories were widely applied in medical practice. Throughout history, these techniques have continuously enriched, developed, and improved, contributing to the health of people in China and around the world.
The term Dao Yin originates from the Huangdi Neijing (黄帝内经) where it states, “The central region is flat and moist, which is why heaven and earth give birth to all things. The people eat a mixed diet without labor, hence they suffer from many diseases such as atrophy and cold heat. The treatment should involve Dao Yin and An Qiao (按蹻), thus Dao Yin and An Qiao also originate from the central region.” Here, Dao Yin and An Qiao refer to the techniques of Tui Na. Wang Bing from the Tang Dynasty explained Dao Yin and An Qiao as: “Dao Yin means to shake the muscles and bones, to move the joints; An means to press the skin and flesh; Qiao means to lift the hands and feet quickly.” This shows that Tui Na is a rehabilitation therapy that combines passive and active movements. Historically, Tui Na has also been referred to as massage, Dao Yin, or Qi movement, and these terms are closely related, forming what is now known as Tui Na studies.
However, today we often think of Tui Na as a passive treatment where the patient receives manual therapy without active movement. This is not the case; the methods of Tui Na for disease prevention and treatment include both manual therapy and Gong Fa (功法) training. Gong Fa training primarily involves active movement, guided by the Tui Na practitioner according to clinical needs, to consolidate and extend the effects of clinical treatment.
1. The Relationship Between Tui Na and Dao Yin
Tui Na and Dao Yin are closely related; they are often referred to together or interchangeably. In the formation of Tui Na as a discipline today, Tui Na includes primarily passive movements of manual techniques and primarily active movements of Dao Yin. This is not a forced association but reflects the true nature of Tui Na and Dao Yin.
Historically, Dao Yin has sometimes been called “massage” or “massage Qigong.” The Tang Dynasty’s medicinal sage Sun Simiao introduced the “Brahman Massage Method” and “Laozi Massage Method” in his work Beiji Qianjin Yaofang, which were named massage methods but were actually various forms of active guiding movements. In the 23rd year of the Republic of China, the Beiping Baorentang bookstore published the “Massage Qigong Yijinjing Illustrated” along with the Twelve-Section Brocade. The Yijinjing is a Dao Yin technique from the Shaolin Temple, and its publication under the name of massage Qigong indicates that Dao Yin belongs to massage.
Tui Na is sometimes also referred to as Dao Yin. The earliest monograph on Dao Yin in China, the Yin Shu, discovered from bamboo slips unearthed in 1984, contains several examples of therapeutic passive Tui Na techniques, such as the supine cervical traction method for treating neck pain, the lumbar stepping method for treating dysentery, and the lumbar extension method for treating throat obstruction, as well as the intraoral reduction method for treating temporomandibular joint dislocation, with commentary on their mechanisms and clinical value. It is believed that these techniques applied to the spine are the earliest records of spinal manipulation in China, and the intraoral reduction method for temporomandibular joint dislocation is also the first record. Dao Yin is not merely active operation; if performed by another person, it can be called Dao Yin techniques, which is essentially Tui Na.
The Cihai dictionary defines Dao Yin as: “An ancient Chinese method of health preservation and disease elimination… involving active limb movements combined with breathing exercises or self-massage for training.” However, from the Yin Shu, it can be seen that Dao Yin includes passive movement techniques. The 15th Five-Year Plan textbook on Tui Na emphasizes that the prevention and treatment of diseases by Tui Na includes both manual techniques and Gong Fa training, indicating that Tui Na includes primarily active Gong Fa training.
Thus, it is evident that Tui Na and Dao Yin are one entity, encompassing both passive manual therapy and active Gong Fa training.
2. Forms of Application of Tui Na and Dao Yin
The forms of application of Tui Na and Dao Yin can involve either manual techniques, Gong Fa, or a combination of both. The combined use of active and passive movements can complement each other, which is an important form of Tui Na and Dao Yin.
In the Sui Dynasty, Chao Yuanfang’s Zhuying Yuanchao Lun describes the method of abdominal massage for treating abdominal distension, which utilizes both manual techniques and Gong Fa: “卷二•风邪论曰：养生方导引法云：脾主土，土暖如人肉，始得发汗，去风冷邪气。若腹内有气胀，先须暖足，摩脐上下并气海，不限遍数，多为佳。如得左回右转三七。……心气放散，送至涌泉，一一不失气之行度，用之有益，不解用者，疑如气乱。”
For example, in modern internal Tui Na schools, the treatment of patients involves practicing Shaolin internal skills, which exemplifies the combination of active and passive movements to enhance efficacy. Practitioners can prescribe exercises from the Yijinjing, Taiji (太极拳), or Baduanjin (八段锦) after manual treatment to extend the effects. For lumbar disc herniation, exercises from the Yijinjing such as the “Hungry Tiger Pounces” can be practiced; for lumbar muscle strain, movements from the Yijinjing like “Green Dragon Explores Claw” can be practiced; and for cervical spondylosis, movements from the Yijinjing like “Nine Ghosts Pulling the Horse Blade” can be practiced.
Gong Fa optimizes manual techniques and enhances the practitioner’s physical condition. Gong Fa training not only refers to the patient’s active movements but also to the practitioner’s active Gong Fa training to enhance their physical condition, optimize techniques, soften their methods, improve their health, and increase treatment efficacy. For instance, the One Finger Zen Manual provides detailed discussions: One Finger Zen Tui Na requires practicing both internal and external skills. One must first practice external skills to ensure that the arms and fingers can bend and flex like cotton. More importantly, one must practice internal skills to regulate breathing, allowing the body’s strength to focus on the fingertips, ensuring that the practitioner’s fingers touch the patient’s body with the softness of cotton. Yet, within that extreme softness, there must also be a degree of firmness… even through thick clothing, one can still press the acupoints… to eliminate diseases swiftly… [7] Here, internal and external skills refer to the internal and external practices of the Yijinjing, which can significantly enhance physical condition. In the Qing Dynasty, Pan Wei pointed out that the Yijinjing is concise and effective, and throughout history, many have achieved extraordinary strength through practicing the Yijinjing, becoming impervious to pulling or pushing, and developing an indestructible body.
3. The Effects of Tui Na and Dao Yin
3.1 Health Preservation (Preventive Treatment)
Techniques such as Yijinjing, Xisui Jing (洗髓经), Baduanjin, Wuqinxi (五禽戏), and Liuzijue (六字诀), along with health-preserving Tui Na massage or self-massage methods like facial massage, ear massage, tooth tapping, abdominal massage, and foot shaking, have health-preserving effects. The Book of the Later Han records the Wuqinxi, which imitates the might of the tiger, the tranquility of the deer, the composure of the bear, the agility of the monkey, and the lightness of the bird, stretching the limbs and moving the joints, serving as a classic method of traditional exercise therapy. Its specific practices are found in Tao Hongjing’s Record of Nurturing Life and Extending Life. The Wuqinxi can help with digestion, increase energy, prevent diseases, and promote longevity.
Yueyang Hospital has applied the Yijinjing or combined techniques to intervene in sarcopenia due to age-related skeletal muscle decline. Skeletal muscle is at its peak between the ages of 20 and 35, gradually declining thereafter, with a slower decline from 35 to 50 years, a 10% reduction in healthy individuals between 50 and 60 years, and a 15% annual reduction in healthy elderly individuals between 60 and 70 years. After 70 years, the annual reduction can reach 30%, accompanied by significant muscle function deterioration. Sarcopenia can lead to decreased muscle strength, joint pain, and trigger diseases such as osteoporosis and osteoarthritis. It causes difficulties in performing daily activities such as walking, climbing, sitting, standing, and lifting objects, gradually leading to challenges in standing up, getting out of bed, unsteady walking, balance issues, and a high risk of falls, increasing the risk of disability and even loss of self-care ability, affecting the elderly’s mental state. After intervention with the Yijinjing or combined techniques, patients showed comprehensive improvements in muscle strength, balance ability, quality of life, and emotional well-being.
3.2 Therapeutic Effects
Tui Na and Dao Yin have numerous therapeutic and rehabilitative effects. Dao Yin is not only for health preservation and prevention but also has many therapeutic effects. For instance, the Neijing Yipian states, “For those with chronic kidney disease, they can face south at the hour of the tiger, calm their mind without distraction, hold their breath without exhaling seven times, guiding the breath down the throat as if swallowing a hard object. Repeat this seven times, allowing saliva to moisten the tongue without limit.” This indicates a rehabilitation method for chronic kidney disease that combines active movement with time. The Zhuying Yuanchao Lun states, “When undressing and lying down, stretch the waist and gaze at the lower abdomen, pausing for five breaths. This guides the kidneys to alleviate thirst… After guiding, walk 120 steps first, more if possible, before eating,” which is a therapeutic exercise for diabetes. The Jingyue Quanshu records methods for treating deafness and tinnitus: sit quietly, lightly place both hands on the knees, close the eyes to nurture the spirit. Lightly press the middle fingers on both ear openings, pressing and releasing repeatedly, then hold and gently shake to guide internal energy, ensuring the ear openings are unobstructed. This is a Dao Yin method for treating deafness and tinnitus. The Neigong Tushuo Jiyao records a method for strengthening the spleen and benefiting the stomach: lying supine, place the right foot on the left foot, stretch both hands to the shoulders, focus on the lower dantian, imagining internal energy circulating around the navel in a clockwise direction, repeating six times. This can treat spleen and stomach deficiency and poor digestion.
3.3 Rehabilitation Effects
The application of Tui Na techniques in rehabilitation is well-known, but Dao Yin has not been widely applied in rehabilitation medicine. In contrast, foreign rehabilitation medicine has extensively researched Taiji, Qigong, and yoga as Dao Yin techniques, achieving significant depth in their studies.
In recent years, traditional Dao Yin techniques such as Taiji, Yijinjing, and Baduanjin have been applied in domestic and international rehabilitation medicine, yielding good results. Taiji can improve the physical and mental conditions of the elderly and enhance balance ability. Yu Minhua and Wang Weidong applied Taiji in hemiplegia training and conducted staged treatment. Research by Chris A McGibbon suggests that Taiji improves vestibular function and enhances balance ability. Research by Chu Yufan and others indicates that practicing Yijinjing for one year significantly improves microcirculation and osteoporosis in the elderly, with three of the four comprehensive scores (morphological score, flow score, and total score) showing significant improvement. This suggests that Yijinjing exercises have a positive therapeutic effect on microcirculation disorders and osteoporosis in the elderly. Research by Zhang Chonghui and Song Aiqiao indicates that Yijinjing exercises positively influence self-assessment of anxiety in the elderly. Research by Zhong Zhibing suggests that fitness Qigong and Yijinjing have a good regulatory effect on the mental health of the elderly. Zhang Wen, Jin Xianqiao, and Chen Wenhua applied the Three-Line Relaxation Technique, elderly COPD breathing exercises, and Baduanjin in the rehabilitation of chronic obstructive pulmonary disease (COPD), finding that traditional exercise prescriptions can improve the exercise capacity of patients in remission and alleviate symptoms of dyspnea. This indicates that Tui Na and Dao Yin techniques are an important breakthrough in modern rehabilitation medicine.
4. Characteristics of Tui Na and Dao Yin
Tui Na and Dao Yin are based on TCM theories, involving passive treatment or self-operation, or autonomous movement, and have their own characteristics.
4.1 Combined with Consciousness Training
Gong Fa training often combines consciousness training.
Consciousness training refers to focusing on a specific body part or following a meridian route to perceive sensations. For example, in the Dao Yin Health Preservation Method for treating stroke: stand upright with the back against a wall, toes spread, calm the mind, and guide the energy from the head down to the toes and soles, repeating twenty-one times until a sensation is felt in the feet… This can “raise the mud pill and lower the spring.” This can treat hemiplegia.
Modern rehabilitation medicine employs visualization techniques in stroke rehabilitation, aligning with traditional Tui Na therapy.
4.2 Combined with Breathing Exercises
Gong Fa training generally incorporates breathing exercises. Breathing exercises, known in ancient times as Tuna (吐纳), Lianqi (练气), Tiao Qi (调气), and Tiao Xi (调息), involve methods such as natural breathing, abdominal breathing, and fetal breathing. They often require breathing to be natural and calm, deep, long, even, and fine.
The Liuzijue involves producing the sounds “Xu (嘘), Ke (咳 or he), Hu (呼), Xi (呬), Chui (吹), Xi (唏)” through different sounds to adjust different organs. For example, “Hu” regulates the spleen, “Ke” regulates the heart, “Xu” regulates the liver and gallbladder, “Xi” regulates the kidneys, and “Xi” regulates the Sanjiao, reflecting the unique theory of the five elements in TCM.
4.3 Adapting to Seasonal Changes
Active Dao Yin movements often correspond with seasonal changes.
The Neijing states, “In the third month of spring… sleep early and rise early, walk widely in the courtyard, let the hair down and relax… In the third month of summer… sleep early and rise early, allowing energy to be released… In the third month of autumn, sleep early and rise early, waking with the rooster, ensuring peace of mind… In the third month of winter, sleep early and rise late, waiting for sunlight… Going against this leads to disasters, following it prevents severe illnesses.” [4] It suggests that lifestyle and exercise must adapt to seasonal changes; otherwise, health and longevity cannot be achieved. Chen Xiyi’s Diagram of the Twenty-Four Seasonal Qi for Disease Prevention reflects the idea that exercise and seasonal changes should correspond.
In summary, Tui Na and Dao Yin are important components of traditional Chinese rehabilitation therapy, and Tui Na also includes active Dao Yin movements, which have unique characteristics. However, these aspects have not received sufficient attention from clinical practitioners, especially Tui Na practitioners. Based on the above issues, the author believes that there should be an emphasis on the health preservation, clinical, and rehabilitation applications and research of Tui Na techniques, while keeping pace with the times, integrating modern rehabilitation medicine and sports medicine to formulate exercise prescriptions to address new issues in the modern disease spectrum.
（Author: Yan Juantao, Yueyang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine）
