Chen Zhi-wei (陈志伟), Shen Yi-jing (沈一菁), Wang Qian (王茜)

1 Tuina Clinic, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

2 Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China

Summary of Professor Jin Yi-cheng’s academic thoughts on pediatric tuina therapy

Chen Zhi-wei (陈志伟)1, Shen Yi-jing (沈一菁)1, Wang Qian (王茜)2

1 Tuina Clinic, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China

2 Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China

To introduce Prof. Jin Yi-cheng’s academic thoughts on pediatric tuina therapy, in order to promote the extensive application of the relevant tuina techniques and the inheritance of famous doctor’s experience, and enhance the clinical effects of tuina in treatment of children’s diseases.

Tuina; Massage; Pediatric Tuina; Famous Doctor’s Experience

Prof. Jin Yi-cheng, a chief doctor, a member of Experts Committee of Shanghai University of Traditional Chinese Medicine, the deputy president of Senior Professors Association of Shanghai University of Traditional Chinese Medicine. He graduated from the Tuina School Affiliated to Shanghai College of Traditional Chinese Medicine in 1963, and started teaching at the school after graduation. Afterward, he had been engaged in clinical practice in Tuina Clinic of Shuguang Hospital, Shanghai University of Traditional Chinese Medicine and Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine respectively, and was promoted to be a chief doctor in 1988. He used to be the director of Pediatric Tuina Clinic, Pediatric Tuina Teaching and Researching Section, the deputy director of Tuina Clinic, director of Tuina Clinic, and director of Tuina Teaching and Researching Section. He used to be the director of Shanghai International Tuina and Acupuncture College, and board director of Tuina Association of Shanghai Traditional Chinese Medicine, deputy director of Pediatric Professional Commission of National Tuina Association, and director of Chinese Medicine and Tuina Association of Changning District, Shanghai.

During the clinical work for over forty years, Prof. Jin has always been working in the first line of medical treatment, education and research in tuina. He compiled and published 40 monographs, and directed eight videos on tuina science[1], among which four types were published in Hong Kong[2], one video was distributed in Japan, and the other three works were authorized and distributed personally by Prof. Jin. In his released works, many types have been printed and distributed for several times, for instance, Pediatric Tuina Therapy[3]was distributed for seven times and printed for over 148 500 copies. China Tuina Therapy[4]compiled for over ten years was collected in the Great British Museum of London (CHI.1993.A.98). This book summarized comprehensively the development history of Chinese tuina science, and medicated paste formula and literature of the different dynasties and washonored as ‘collection of China tuina’ by Mr. Zhou Gu-cheng (a famous historian).

Based upon pediatric tuina science predominantly, and by integration into three schools of Shanghai-style one thumb tuina, Gun-rolling tuina, and tuina by internal energy, he has put forward the viewpoints of‘Shanghai pediatric tuina science’ in accordance with the development history and features of Shanghai pediatric tuina science[5]. He believes that Shanghai pediatric tuina is integrated with features of other styles and characterized by the local feature. There is no original style in Shanghai. But, all rivers run into sea. We are lucky to learn with Prof. Jin for many years and have been benefited greatly great deal. Now, Prof. Jin’s academic thoughts are summarized as follows.

1 Main Academic Thoughts

1.1 Integrating three major manual techniques of Shanghai into pediatric tuina science

Eight methods of pediatric tuina refer to the basic manual techniques of traditional pediatric tuina, i.e. An-pressing, Mo-rubbing, Qia-finger-nail-pressing, Rou-kneading, Tui-pushing, Yun-circular-pushing, Cuo-twisting and Yao-shaking techniques. There are other techniques of Dao-pounding, Dou-vibrating, Nie-pinching, and Gua-scratching. By integrating the major manual techniques of Shanghai, such as manipulations of one-thumb Tui-pushing, Gun-rolling and scrubbing, into the traditional tuina techniques, Prof. Prof. Jin summarized ten major manual techniques of pediatric tuina science[1], including An-pressing, Mo-rubbing, Nie-pinching, Rou-kneading, Tui-pushing, Na-grasping, Cuo-twisting, Yao-shaking, Gun-rolling and Ca-scrubbing, for clinical application.

The integration of those techniques not only intensifies the soft and permeating effect of manual techniques of pediatric tuina, expressing the manual technique of ‘light but not floating, heavy but not stagnant’ and enhancing the clinical effect to a certain degree, but also expands the application scope of the manual techniques, laying a solid foundation for expanding the indications of pediatric tuina science.

The Tui-pushing manipulation in pediatric tuina is a comparatively specific technique, including rotating Tui-pushing, straight Tui-pushing, parting Tui-pushing, joined Tui-pushing, and circular Tui-pushing. The rotating Tui-pushing manipulation refers to the technique to rotate, push and rub clockwise with the palmar surface of the thumb, by movement of the thumb in small amplitude, and at high frequency for 150-200 times per minute. It is used mainly for planar acupoints of the hand, such as Pijing (Figure 1), Shenjing, etc. The rotating Tui-pushing manipulation is generally used as reinforcing method. The straight Tui-pushing manipulation refers to the technique to push straightly in one direction with the radial side or palmar surface of the thumb, or palmar surface of the middle finger, by the adduction and abduction of the thumb, at higher frequency, for about 250-300 times per minute. It is often used for linear or planar acupoints, such as Tianmen, Dachang, Feijing, Sanguan, etc. This technique has dredging and dispersing action. These two types of manual techniques are most frequently used in clinical application of pediatric tuina. The long-term operation will cause aching soreness at the thumb joint and even cause joint injury. Based upon clinical experience for many years, Prof. Jin integrates the moving shape of the one-thumb pushing method and rolling method, and the wrist-relaxing key points, into manual techniques of pediatric tuina, by guiding the movement of the thumb with flexion and extension of the wrist joint, and reducing the moving amplitude of the flexion and extension of the thumb joint, so as to avoid joint injury. By Prof Jin’s modification of the manual technique, not only the manual technique can be used more easily but also become softer and more permeative.

Figure 1. Reinforcing Pijing

The integration of one-thumb Tui-pushing and Gun-rolling manipulations into techniques of pediatric tuina also expands the disease spectrum. For instance, Prof. Jin lists the intractable diseases including teenager scoliosis, cerebral palsy, masturbation syndrome, and epilepsy as the indications of pediatric tuina, greatly expanding the indication scope of pediatric tuina.

1.2 Putting forward the viewpoint of ‘acupoint area’[1]Generally, tuina is supposed to stimulate the acupoints, meridians and muscle regions. Prof. Jin believes that to stimulate the acupoints, for instance, to Tui-push or Na-grasp certain acupoint or certain meridian, means to stimulate an area with an acupoint as the center. Take the smaller stimulating spot of onethumb Tui-pushing and finger Tui-pushing manipulations, for example, the acupoint the finger tip touches is much larger than the needle tip. Moreover, in some specific acupoints in pediatric tuina, in addition tospot acupoint, there are linear acupoints and planar acupoints, and even certain region is a specific acupoint. For instance, the whole abdomen is exactly a specific acupoint, ‘Abdomen’ (Figure 2). Therefore, it is quite appropriate to term the stimulating area in tuina science as ‘acupoint area’.

Figure 2. Abdomen

Besides, Prof. Jin is not limited to the specific acupoints stipulated by ancient people. In his clinical practice, he not only integrates the manual techniques of other styles and also renews some practical ‘acupoint area’ in accordance with practical diseases in children. For instance, Tui-pushing Qiaogong is exactly the method introduced from internal energy tuina school.

1.3 Emphasizing ‘dredging method’[1]

The therapeutic principle in pediatric tuina is basically similar to that in the internal medicine. In the treatment, it is necessary to get the essence of diseases, and distinguish the real condition of the symptoms and causative factors, and to treat both the symptoms and causative factors, or support the constitution and expel pathogens, or use the attacking action and reinforcing action simultaneously, and to treat similar diseases with different therapies and to treat different diseases with similar therapies.

The eight methods of sweating, vomiting, purgative, eliminating, harmonizing, clearing, warming and reinforcing mentioned in Yi Xue Xin Yu (Medical Insights) were summarized by the forefathers based on their long-term medical practice. Prof. Jin believes that in addition to the eight methods, there is another important therapeutic method in tuina clinical practice, i.e. the dredging method.

The dredging method is guided by the meridian theory and commonly used in tuina science. Tuina can soothe the meridians, dredge the collaterals, circulate qi and activate blood for ‘nourishing yin and yang, moistening the tendons and bones, and lubricating the joints’. In tuina practice, painful spot is often regarded as the area for treatment. Therefore, Prof. Jin points out the viewpoint of ‘dredging method needed for pain, no dredging method needed for no pain’. This viewpoint is not in contradiction with the viewpoint of ‘pain induced by blockage and blockage inducing pain’. The former refers to the therapeutic mechanism, and the latter refers to the pathogenic mechanism.

In clinic, Prof. Jin treats the diseases of infantile cough and panting with sputum, abdominal distension, abdominal pain, food retention, constipation, acute and chronic convulsions with remarkable therapeutic effects by the manual techniques to promote and dredge the lung qi, regulate the intestines and dredge the hollow organs, the orifices, the meridians and extinguish wind.

1.4 Stressing ‘to support the constitution and consolidating the foundation’[1]

Clinically, Prof. Jin stresses the treatment based upon pattern identification and holistic treatment. In accordance with the physiological and pathological features of children, Prof. Jin believes that children are of ‘pure yin and pure yang’, and ‘qi is already deficient, if pathogen invades’. Therefore, in the treatment, he stresses to take care of the anti-pathogenic ability, i.e. by the method to ‘consolidate the foundation’. It is believed in Chinese medicine that the kidney is the prenatal foundation and the spleen and stomach are the postnatal foundation. In the treatment of children’s diseases, it is necessary to reinforce the spleen and benefit the kidney for the diseases in relation to the spleen and stomach and for diseases in relation to the kidney, and also necessary to adopt the techniques to reinforce the spleen and benefit the kidney in the treatment of the relevant diseases, such as asthma, cerebral palsy, etc.

In current clinic, in the big cities in particular, chronic diseases are in majority. ‘Symptoms should be treated in emergent condition, and causative factors should be treated in remission stage.’ Therefore, the main therapeutic principle is to treat the causative reason. The foundation must be consolidated for children with spleen deficiency or kidney deficiency. With the change in the living environment and enhancement of the living condition, healthcare for children has been increasingly emphasized. In Chinese medicine, it is emphasized to‘treat unformed diseases’. To balance yin and yang by the foundation-consolidating method is beneficial to the healthy growth of children.

Generally, Prof. Jin sums up and develops tuina experience of the forefathers constantly in his practice, and his academic viewpoints are suitable for the clinical practice of tuina science.

2 Case Reports

2.1 Treating diarrhea with tuina

General situation: A sick girl, 13 months old, first visited on July 6, 2012.

Chief complaints and current history: The child suffered from diarrhea for three days, 4-5 times per day, manifested by loose stools, foul like putrid egg, mixed with milk flakes, and a little mucus, low spirit, accompanied by vomiting, poor appetite, diarrhea immediately after breast feeding, a red tongue with thick and greasy coating, and a slippery pulse.

Analysis: The child’s stool, foul like putrid egg, mixed with milk flakes and a little mucus, belongs to diarrhea due to improper diet in infantile diarrhea.

Therapeutic principle: To strengthen the spleen and harmonize the stomach, digest food and stop diarrhea.

Prescription: To Qing-clear Weijing for 100 times, Bu-reinforce Pijing for 300 times, Bu-reinforce Dachang for 100 times, circularly Tui-push Pijing all the way to Shenjing for 30 times, Rou-knead Zhongwan (CV 12) clockwise for 100 times, Rou-knead the umbilicus and Tianshu (ST 25) clockwise for 100 times (Figure 3), Mo-rub the abdomen counterclockwise for 3 min (Figure 4), and Rou-knead Guiwei for 60 times (Figure 5), Tui-push Shangqijiegu for 60 times, and Rou-knead Baihui (GV 20) for 30 times. The treatment was given once per day.

Figure 3. Rou-kneading the umbilicus and Tianshu (ST 25)

Figure 4. Mo-rubbing the abdomen counterclockwise

Treatment process: On the second visit on July 9, 2012, the parents told that the child’s diarrhea was obviously relieved after three sessions of tuina treatment, just 2-3 times per day, in paste shape, occasionally mixed with milk flakes, a red tongue with slight greasy coating, and a thready pulse. The treatment was given continuously. On the third visit on July 15, 2012, the parents told that the diarrhea was eliminated and stool was formed in soft nature. Appetite and greasy coating were obviously improved than before. The original prescription was given to Qing-clear Weijing and Xiaochang, and Bu-reinforce Dachang. Bu-reinforcing Shenjing for 300 times, and Nie-pinch spine (Figure 6) for 5 times were added to consolidate the therapeutic effect. The child was cured after another three sessions of the treatment.

Figure 5. Rou-kneading Guiwei

Figure 6. Nie-pinching spine

Explanation: This disease is infantile diarrhea. In modern medicine, infantile diarrhea is regarded as a commonly encountered pediatric disease just next to infection of the respiratory tract and it can be divided into infectious type and non-infectious type in etiology[6]. The infectious factors are virus, bacteria and parasites, with virus in majority, rotavirus in leading position in particular. The non-infectious factors are majorly related to dietetic reasons of improper feeding, food allergy, lack of certain enzyme inside the body, and gastrointestinal dysfunction induced by weather change.Clinically, over and frequent use of antibiotics and antidiarrheal drugs would easily linger the symptom of diarrhea. The long-term use of antibiotics can also induce infantile intestinal dysbacteriosis, which not only damage the digestive function of children but also impact the growth and development of children. Tuina therapy for infantile diarrhea has a long history, convenient in operation and affirmative in the therapeutic effect, economic and safe. Prof. Jin believes infantile diarrhea is fundamentally related to the spleen and stomach. The children are full of vigor and quick in the development, their development of yin and yang needs to be fully supplied with the essential stuffs of water and grain, processed by the spleen and stomach. Therefore, the burden of the child’s spleen and stomach is comparatively heavy. At the same time, because children are delicate in Zang-fu organs and insufficient in the shape and qi, and their spleen and stomach are relatively weak, infection of exogenous factors, internal injury of milk food and long-term sickness can induce dysfunction of the spleen and stomach, leading to diarrhea.

In accordance with clinical manifestations of this child, it belongs to infantile diarrhea induced by improper diet. In the therapeutic principle and method, the clarifying technique and reinforcing technique are used simultaneously in the initial stage, and the technique to reinforce the spleen and consolidate the kidney is used in the later stage. The whole therapeutic process greatly reflects the essence of Prof. Jin’s thought on ‘dredging action’ and ‘consolidating action’. In terms of ‘dredging action’, namely in the initial stage, the child is manifested with diarrhea, but diarrhea is foul like putrid egg and mixed with undigested food, a sign of internal retention of dregs, and it is supposed not to stop diarrhea blindly but to dredge qi of the hollow organs and clean the intestine, so as to discharge the dregs and avoid retaining the pathogen internally, and obtain the therapeutic effect. The ‘consolidating action’ is based upon the physiological feature of ‘delicate Zang-fu organs’ in children. In the consideration of insufficiency of the spleen qi, deficiency will be worse after diarrhea. Therefore, in the initial treatment, the method to consolidate the constitution and reinforce the spleen is combined to strengthen and promote the spleen qi, in order to avoid serious diarrhea and consume qi and damage body fluid. In the later stage of the disease, the child’s dregs are already removed and the intestines are dredged, but of the body constitution is not restored. Therefore, based upon the reinforcement of the spleen, the kidney is benefited to intensify the effect ‘to support the constitution and consolidating the foundation’. In the operation, Prof. Jin adopted the techniques to Qing-clear Weijing, Qing-clear Xiaochang, and Rou-knead Zhongwan (CV 12) clockwise, Rou-knead the umbilicus clockwise and Rou-knead Tianshu (ST 25) clockwise for removing pathogens from the intestines, and to Bu-reinforce Pijing and Dachang, and Mo-rub the abdomen counterclockwise, Rou-knead Guiwei, Tuipush Shangqijiegu, and Rou-knead Baihui (GV 20) for correcting deficiency and raising qi. In the later stage, the techniques to Bu-reinforce Shenjing and to Nie-pinch spine are added to intensify the effect for supporting the constitution and consolidating the foundation, so as to cure the child. To Mo-rub the abdomen, Rou-knead Guiwei and Nie-pinch spine are the ‘acupoint areas’ of Prof. Jin uses with good effects in treatment of infantile diarrhea. To Mo-rub the abdomen is able to regulate the peristalsis of the stomach and intestine and intensify the digestive and absorptive function, so as to strengthen the spleen, harmonize the stomach and stop diarrhea, by counterclockwise motion for reinforcement and clockwise motion for reduction, so as to reinforce the spleen and stomach and remove food retention, for realizing the goal to stop diarrhea. To Rou-knead Guiwei is able to excite the nerve to dominate the anal sphincter and regulate the function of the anal sphincter, so as to stop diarrhea and clear away heat. The modern experimental study has proven that Nie-pinching spine can improve the activities of the autonomic nerve of the cerebral cortex, increase the secretion of digestive juice and digestive enzyme, elevate the serum protein retention rate, activate the hematopoietic function, regulate the activity of enzyme and improve the absorptive function of the small intestine. Therefore, no matter for what type of infantile diarrhea, those ‘acupoint areas’ can be used flexibly.

2.2 Treating infantile muscular torticollis with tuina

General situation: A sick girl, 33 d old, first visited on February 14, 2012.

Chief complaints and current history: Lump on the right neck for 20 d. Before 20 d, the parent of the child touched a lump on the right neck of the child accidently and sought medical treatment in Xinhua Hospital. After the physical examination and B-ultrasonic examination,‘infantile muscular torticollis’ was diagnosed and the child was taken to the clinic of our hospital for conservative treatment. The child was born by term, natural birth and first pregnancy. The mother preferred static and disliked moving, and lying on one side.

Physical examination: The head deviated to the right side and was limited to turn rightward, with a lump on the right neck, in about 12 mm × 15 mm, with smooth surface, clear border, hard texture, asymmetrical face, the two eyes with different sizes, normal hip joint. B ultrasonic examination of the neck showed lump on the right sternoclaccomastoid muscle.

Analysis: Based upon the symptoms, signs and auxiliary examination of the child, infantile muscular torticollis was diagnosed and belonged to ‘tendon node’in Chinese medicine.

Therapeutic principle: To activate blood, dredge the collaterals, soothe the tendons and disperse node.

Prescription: To An-press, Rou-knead and Tanbopluck Qiaogong alternatively for 5 min (Figure 7), Na-grasp and Nie-pinch Qiaogong for 1 min (Figure 8); Bashen-pull and extend the neck passively (Figure 9) (after 5 times of short Bashen-pulling and extending motion, hold the Bashen-pulling and extending motion for 1 min, repeatedly for four times), An-press and Rou-knead the bilateral neck muscle and trapezius muscle for 2 min, and Na-grasp Jianjing (GB 21) for 20 times. The treatment was given once per day, for five sessions per week, rest on weekend.

Figure 7. An-pressing, Rou-kneading and Tanbo-plucking Qiaogong

Figure 8. Na-grasping and Nie-pinching Qiaogong

Therapeutic process: On the second visit on April 19, 2012. The parents of the child told that after the treatment, the child’s head still deviated rightward, but the activity to turn rightward was increased than before, and the lump on the right neck was diminished than before and its texture became soft. The face still looked asymmetrical and two eyes were still different in size. The B-ultrasonic examination showed the lump of the right sternocladomastoid muscle was smaller than before. The treatment was continued with the original prescription. On the third visit on June 12, 2012, the child’s head deviated to right side less than before and turned rightward more than before. The lump on the right neck was not obvious and the face was not obviously asymmetrical. But the two eyes were still different in size, improved than before. B-ultrasonic reexamination of the neck showed that the right sternocladomastoid muscle was thickened. The treatment was continued with the original prescription. On the fourth visit on August 11, 2012, the deviation was not obviously after treatment, and the head turned outward better. The lump on the right neck disappeared and the asymmetrical situation of the face and eyes was not obvious. B-ultrasonic reexamination of the neck showed that no abnormality was seen in the bilateral sternocladomastoid muscles.

Figure 9. Bashen-pulling and extending the neck

Explanation: This disease is infantile muscular torticollis. The modern medicine holds that it is mostly caused by muscular fiber spasm due to the extrusion of the birth canal or forceps during delivery, or malposition, etc. It is often seen during delivery or several months after birth, and the incidence rate is about 0.2%-0.5%, clinically manifested by deviation of the head to one side, with secondary asymmetry of the face and head. If not treated promptly and properly, the deformity will be aggravated increasingly with the age, seriously influencing the face of the child, and influencing the mind, work and marriage.

It is believed in Chinese medicine that infantile muscular torticollis belongs to ‘tendon spasm’ or‘tendon node’, and is usually caused by injury of the muscular tendons and retention of blood stasis in the neck of the child, leading to spasm of the muscles and tendons. The early contraction of the muscular tendons will induce tendon node, i.e. formation of lump. Due to the long-term lack of treatment, muscular contraction will cause muscular spasm, i.e. cord-like formation in the sternocladomastoid muscle. In Western medicine, this disease is mainly treated by surgery. Because the children are young when this disease is discovered, and the risk of surgery anesthesia, therefore most scholarsadvocate that surgery is not appropriate for sick infants within one year old, and the conservative treatment is advisable. The surgery is suggested only when there is no obvious effect. Tuina treatment is better in therapeutic effect, safe and free of side effect. Pediatric tuina treatment is a priority for this problem. Prof. Jin believes that the younger the age of the child with this problem is, the better the therapeutic effect will be. The therapeutic effect is remarkable and the curative rate is high, if the treatment starts when the child is within one month old. Therefore, it is necessary to discover and treat early.

Based upon his clinical experience for many years, Prof. Jin sums up ‘four-step tuina method’ for infantile muscular torticollis[7]. The therapeutic principle for the child in this case is based upon ‘dredging method’, to activate blood, dredge the collaterals, soothe the tendons and disperse node as the main line. Prof. Jin puts forward the viewpoint to ‘soothe the tendons, relax spasm, soften the hard, diminish swelling, pull and extend to correct the deformity’, and designs the following plan based upon the extensive study of the literature and clinical practice: to soothe the tendons and relax spasm by the pressing, kneading and plucking technique, to soften the hard and disperse node, and diminish and eliminate the lump by the grasping and pinching technique, and to correct the deformity and torticollis by Bashen-pulling and extending the sternocladomastoid muscle. In tuina manual techniques, this problem is mainly treated by the pressing, kneading, plucking, grasping and pinching technique as the main line. Among them, the two manipulations of Na-grasping and Nie-pinching are exactly the reflection that Prof. Jin integrates Shanghai-style tuina and traditional pediatric tuina techniques dynamically. Based upon the relaxation by Na-pressing and Rou-kneading manipulations, Na-grasping, Nie-pinching and Tanbo-plucking manipulations are used to intensify the effect to dredge the collaterals and disperse node, particularly suitable for infantile tendon problem. In the selection of ‘acupoint areas’, Prof. Jin takes in the contents to Tui-push Qiaogong in tuina science of internal energy, and focuses the treatment on‘Qiaogong’, enriching the theory of pediatric tuina[8-9]. For this disease, Prof. Jin stresses to diminish swelling and disperse nodes, and requests to be gentle and penetrative in the power and short in time in the operation. Besides, before each treatment session, it is necessary to relax the relevant muscle groups generally, in order to avoid stiffness in the surrounding muscular tissues of the sternocladomastoid muscle.

2.3 Treating infantile cerebral palsy with tuina

General situation: A sick girl, seven months old, first visited on January 8, 2012.

Chief complaints and current history: Seeking medical treatment because of the child’s soft neck accompanied by paralysis and flaccidity in the four limbs for three months. Three months ago, the parents of the child discovered the child was soft in the neck and unable to raise the head, but did not seek medical treatment. One month later, they found that the child was still unable to raise the head, plus paralysis and flaccidity in the four limbs, and went to seek medical treatment in children’s hospital. After assessment, the child was diagnosed as‘cerebral palsy’ and was given rehabilitative treatment. In order to seek comprehensive treatment, they came to Prof. Jin’s clinic. At that moment, the child was soft in the neck, accompanied by emaciation, flaccidity and paralysis in the four limbs, pale complexion, sparse hair, dull expression, slow reaction, poor appetite, loose stool, peaceful sleep, a pale tongue with scanty coating, and a thready pulse.

Analysis: Based upon the diagnosis of other hospital, the child was confirmed as ‘infantile cerebral palsy’. The pattern is related to deficiency of the liver and kidney in Chinese medicine.

Therapeutic principle: To reinforce the kidney, refill marrow, nourish the liver and strengthen the tendons.

Prescription: To Bu-reinforce Pijing and Shenjing for 300 times, Rou-knead Zhongwan (CV 12) for 3 min, Rou-knead Qihai (CV 6) and Guanyuan (CV 4) for 3 min, Mo-rub the abdomen for 3 min, An-press and Rou-knead Zusanli (ST 36) for 100 times, Tangbo-pluck Yanglingquan (GB 34) for 100 times, An-press and Rou-knead Yongquan (KI 1) for 100 times, push the spine by one-thumb Tui-pushing technique (Figure 10) and the Bladder Meridian respectively for two processes, Nie-pinch spine for 5 times, Ca-scrub the Governor Vessel (Figure 11) for 10 times, An-press and Rou-knead Baihui (GV 20) for 60 times, An-press and Rou-knead Jianyu (LI 15), Jianliao (TE 14), Quchi (LI 11) and Binao (LI 14) for 1 min, Na-grasp the two upper limbs for 5 times, Yao-shake the shoulder, elbow and wrist joint of the two upper limbs respectively for 5 times, An-press and Rou-knead Huantiao (GB 30), Juliao (GB 29), Biguan (ST 31), Chengfu (BL 36), Weizhong (BL 40), and Chengshan (BL 57), Gun-roll the buttocks and the lower limb for 1 min, Na-grasp the two lower limbs for 5 times, and Yao-shake the hip, knee and ankle joints respectively for 5 times. The treatment was given once every second day.

Therapeutic process: The second visit was on October 12, 2012. After tuina and rehabilitative treatment for nearly ten months, the child was able to raise the head slowly, with the muscles in the four limbs full than before and muscle force improved somewhat, and able to stand up slowly by the help of the others and stand independently, and able to respond to sound and color of the external environment, and able to eat more than before, though lose stool still present, and able to sleep peacefully. Under the suggestion of Prof. Jin, the parents continued the treatment through the growth of thechild. After the treatment for over three years, the child could grow and develop basically normally, with easy expression, normal hair and without disturbance in the activity of the limbs in daily life.

Figure 10. Tui-pushing the spine by one-thumb Tui-pushing manipulation

Figure 11. Ca-scrubbing the Governor Vessel

Explanation: This disease is infantile cerebral palsy, refers to the developmental disorder due to injury or lesion, appearing before the maturity of the brain and is a syndrome mainly manifested by non-progressive central movement disorder and abnormal posture. This disease impacts the development of the children’s body, and ability, personality and cognition, impacts his or her relationship with the family and society and is one of the main diseases to cause deformity in children. In the developed countries, the incidence rate is about two thousandth, and is about 1.5‰-5‰ in China. In recent years, the incidence rate is in a continuous increasing tendency. It belongs to an intractable disease and also a worldwide difficult issue. This disease belongs to the scope of ‘five types of retardation’, ‘five types of weakness’ and ‘five types of stiffness’, ‘flaccid paralysis’and ‘dementia’ in traditional Chinese medicine, mostly caused by deficiency of kidney essence and insufficiency of qi and blood, leading to malnutrition of the tendons and bones and insufficiency of brain marrow. It is believed in Chinese medicine that this disease is related to insufficiency of the liver and kidney and weakness of the spleen and stomach. Because the etiology and symptoms are complicated, it is mostly treated with comprehensive means in modern medicine, such as rehabilitation, acupuncture, and tuina therapy, etc.

For this disease, Prof. Jin focuses to ‘support the constitution and consolidate the foundation’, to benefit the kidney, reinforce the liver and strengthen the spleen. Because the kidney is a prenatal foundation, to reinforce the kidney is able to directly nourish the brain marrow. The liver dominates the tendons, from the same source of the kidney. Therefore, the liver is reinforced to strengthen the tendons. The spleen and stomach are a postnatal foundation, dominate the muscles and can produce and transform qi and blood, and supplement the muscles. In this case, the child’s four limbs are paralyzed and weak, plus the typical signs of deficiency of the spleen, stomach, liver and kidney, such as lusterless complexion, sparse hair, dull expression and slow reaction. Therefore, techniques to Bu-reinforce Pijing and Shenjing, Rou-knead Zhongwan (CV 12), Mo-rub the abdomen, and An-press and Rou-knead Zusanli (ST 36) and Yanglingquan (GB 34) are applied to benefit the kidney, reinforce the liver and strengthen the spleen. Baihui (GV 20) is Rou-kneaded to stimulate the development of the brain. Besides, in the selection of acupoints, Prof. Jin stresses the ‘acupoint areas’ around the spine, because the back is just where Back-Shu acupoints are, and the confluent sites of yin and yang of Zang-fu organs, and is the sites where the essential qi of Zang-fu organs flows. Judging from the pathways of the meridians, the Governor Vessel starts from Changqiang (GV 1), goes upward through the spine to Fengfu (GV 16) and enters the brain; and the Bladder Meridian goes bilaterally along the spine. The pathways of the above two meridians are exactly the major areas for tuina application. The Governor Vessel is the sea of all yang meridians and can govern yang of the whole body. If the Governor Vessel is obstructed, all the other meridians will be obstructed. No matter the problem is in qi or blood, the treatment can be given on the spine to obtain therapeutic effect. Prof. Jin absorbs and uses ‘one-thumb Tui-pushing technique’ on the spine and the Bladder Meridian of the back, in combination with the techniques to Nie-pinch spine and Ca-scrub the Governor Vessel to regulate yin and yang, excite yang qi, circulate qi and blood, and harmonize five Zang organs at the same time, in order to promote the development better. The operation on the above‘acupoint areas’ precisely reflects the essence to‘support the constitution and consolidate the foundation’. Besides, in accordance with the paralyzed and soft limbs of the child in this case, the treatment is also given to deal with both the symptoms and causative factors externally and internally, by thetechniques to An-press and Rou-knead Jianyu (LI 15), Jianliao (TE 14), Binao (LI 14), and Quchi (LI 11) and Na-grasp and Cuo-twist the upper limb, in combination with various passive movement of the upper limbs, in order to intensify the functions of the upper limb, and by the techniques of An-pressing and Rou-kneading Huantiao (GB 30), Juliao (GB 29), Chengfu (BL 36), and Weizhong (BL 40), and Gun-rolling the buttocks and lower limbs, in combination with various passive movements of the lower limbs, to enhance the functions of the lower limbs.

Tuina therapy is positive for developments of limbs and intelligence of the children with cerebral palsy. Anyhow, this disease is difficult to treat. Therefore, the parents and family will have to suffer from great pain. Therefore, the doctors need to pay their love, patience and goodness to the children and their parents.

2.4 Treating juvenile idiopathic scoliosis with tuina

General situation: A six-year old girl, first visited on March 29, 2012.

Chief complaints and current history: Abnormal spinal curvature discovered for four days. The mother of the child discovered the abnormal spinal curvature of the child during bath, with the right shoulder slightly higher than the left shoulder. But the child did not have any obvious discomfort. They went to seek medical treatment in Xinhua Hospital. X-ray examination showed the spine was in ‘S’ scoliosis, and Cobb angle was 35°, without obvious occupational change. Therefore, they came to our hospital for conservative treatment.

Physical examination: Scoliosis was in ‘S’ shape, with limited protrusion on one side of the back, and tenderness in the protruded position. The cervical and thoracic segment deviated to the right side. The thoracic and lumbar segment deviated to the left side. The lower angles of the bilateral scapula were at the same level of the bilateral iliac wings.

Analysis: In accordance with the symptoms, signs and results of examinations, scoliosis was diagnosed.

Prescription: After the child took a prone position, the therapist Rou-kneaded the bilateral Bladder Meridian with the palm from the top to the bottom for 5 times, Gun-rolled the bilateral Bladder Meridian for 3 min, Rou-kneaded Jiaji (EX-B 2) points from the top to the bottom for 2 min, and An-pressed and Rou-kneaded Ganshu (BL 18), Pishu (BL 20) and Shenshu (BL 23) respectively for 1 min, and Ca-scrubbed the sacrospinal muscles. After the child took a sitting position, the therapist applied the rotating restoration of the thoracic vertebrae[1](Figure 12), in order to correct the staggered joints of the thoracic vertebrae. The treatment was given once every second day, for three sessions per week.

Therapeutic process: The second visit was on October 8, 2012. After treatment of half a year, the child was obviously improved in the spinal curvature. X-ray examination showed a mild ‘S’ shape of the spinal curvature, and Cobb angle smaller than 20°. After a period of treatment, the bilateral shoulders of the child were almost at the same level, without obvious protrusion on the back, without tenderness and obvious abnormality in the external body shape.

Figure 12. Rotating restoration of the thoracic vertebrae

Explanation: The spinal curvature refers to certain segment of the spine deviating from the midline of the body, mainly manifested by ‘S’ shape of the spine. The spinal curvature is a common disease in the teenagers in China. By statistics, its incidence rate is as high as 1.06%, in which the specific spinal curvature accounts for over 85% of the total population of the patients with the spinal curvature, and its ratio between the males and females is 0. 51:1. In traditional Chinese medicine, it belongs to the scope of ‘turtle back’.

In 1980s, Prof. Jin started to study tuina therapy for infantile spinal curvature. He found out that because of heavy burden in school works and lack of sports, the incidence rate of the spinal curvature tends to increase. This disease is not easy to be discovered in the early stage. As a result, because the best period is often missed for the conservative treatment, the surgical treatment has to be adopted, inducing great harm to the body and mind of the child. Prof. Jin used to investigate the various middle and primary schools in Shanghai, to understand the pathological situation of the spine curvature in the juveniles, and used to collect over thousand cases for clinical study, proving that tuina therapy is remarkable in the therapeutic effect and painless in treatment of the spinal curvature.

Prof. Jin believes that the best moment to treat infantile spinal curvature is before the maturity of the bones, and the earlier the treatment is given, the better the therapeutic result will be. The therapeutic principle is based upon ‘dredging method’ and ‘foundationconsolidating method’. The ‘dredging method’ is supposed to soothe the meridians, activate thecollaterals and correct the deformity. For instance, to Gun-roll the bilateral Bladder Meridian and Ca-scrub the sacrospinal muscles can reflect Prof. Jin’s vivid style in integrating Shanghai-style pediatric tuina into traditional tuina techniques. The most important spine-setting technique in treatment of this disease also shows that the essentials of bone-setting are flexibly, and properly used in treatment of infantile diseases, giving a corrective effect directly for curved spine. In the practical operation, the requirements for the therapists are comparatively high, including accurate location and proper force, and psychological confidence of the children to the therapists in the use of the manual techniques, which the therapists should gradually experience and master in their clinical practice. By clinical observation for many years, Prof. Jin found out that the children are mostly girls, in emaciated body, poor constitution and lack of sports. It is clear that the occurrence of this disease is related to insufficiency of the liver and kidney and malnutrition of the tendons and muscles. Therefore, the treatment should be designed from the holistic viewpoints, to support the constitution and consolidate the foundation in particular based upon ‘dredging method’, and to reinforce and benefit the liver and kidney, regulate and harmonize Zang-fu organs, and dredge the meridians and collaterals by An-pressing and Rou-kneading Back-Shu acupoints of Ganshu (BL 18), Pishu (BL 20) and Shenshu (BL 23), so as to improve the nutrition for the muscles, nerves and bones. The spinal curvature often occurs in the relation to improper body posture of the children and lack of sports. Therefore, the parents should carefully correct bad body posture and habit of the children[10].

The spinal curvature is not commonly treated by pediatric tuina therapy. In inheriting the traditional healing art, Prof. Jin absorbs various styles, continuously brings forth new manual techniques of Shanghai-style pediatric tuina techniques and expands the indication scope of pediatric tuina therapy.

3 Conclusion

Pediatric tuina therapy has a long history. With his kindness and universal love, Prof. Jin has been carefully studying pediatric tuina therapy for dozens of years. He seeks the ancient experience diligently and also absorbs various styles. In conformity with the special physiology of the children, he emphasizes the ‘dredging and regulating method’ in the therapeutic method and stresses to ‘support the constitution and consolidate the foundation’. In terms of the manual techniques, he integrates Shanghai three major tuina styles of one-thumb technique, Gun-rolling method and internal energy into the traditional pediatric tuina techniques, bringing forth new techniques, keeping the steps with the times and greatly expanding the indication scope of pediatric tuina therapy, and producing a brand new vitality to the ancient and green therapy of pediatric tuina therapy. As a treasure in the tuina circle in China and even in the whole circle of Chinese medicine, his academic thoughts and clinical experiences need to be further summarized and studied profoundly.

Conflict of Interest

There was no potential conflict of interest in this article.

Acknowledgments

This work was supported by Training Program of the Talents for TCM Rare Clinics and Specific Diagnostic and Therapeutic Techniques (Only Love Angle Fund of Shanghai Charity Foundation)[中医紧缺专科、特色诊疗技术传承人才培养项目(上海市慈善基金会之唯爱天使基金)]; Construction Item of National Clinical Key Specialties (国家临床重点专科建设项目, No. ZK0901TN007); Ding’s Tuina Project of Three-year Action Plan of Shanghai Chinese Medicine Development (Inheritance Project of Shanghai-style Chinese Medicine) [上海市中医药事业发展三年行动计划（海派中医流派传承工程)丁氏推拿项目, No. ZYSNXD-CC-HPGC-JD-011].

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[2] Jin YC. Healthcare of Pediatric tuina Therapy. Shanghai: Shanghai Joint Publishing Press, 1989.

[3] Jin YC. Pediatric Tuina Therapy. Shanghai: Shanghai Science and Technology Literature Press, 1981.

[4] Jin YC, Peng J. China Tuina Therapy. Changsha: Hunan Science and Technology Publishers, 1992.

[5] Jin YC. Formation of Pediatric tuina Therapy. Proceedings of National Seminar on TCM and Pediatric tuina Therapy, 2009.

[6] Xue XD, Jin YC. Pediatrics. 2nd Edition. Beijing: People’s Medical Publishing House, 2010: 250.

[7] Chen ZW, Sun WQ, Jin YC, Shen YJ. Observation on clinical effects of ‘four-step method’ tuina treatment for 53 cases of infantile muscular torticollis. Zhongguo Zhongxiyi Jiehe Erkexue, 2011, 3(4): 291.

[8] Shen ZF, Luo KT, Zhu GF, Jin YQ. Tuina plus ultrasonic therapy for infantile muscular torticollis. J Acupunct Tuina Sci, 2014, 12(6): 389-392.

[9] Feng Y, Yang J, Yang X. Brief study on source of qiaogong. Jilin Zhongyiyao, 2010, 30(6): 542-543.

[10] Sun DL, Chen DL, Ni CH, Zhang Y, Wang XF, Ma HF, Jiang HX. Randomized controlled trial of acupuncture plus behavior therapy for cervical spondylosis and cervical spondylotic radiculopathy. Shanghai Zhenjiu Zazhi, 2011, 30(6): 399-402.

Translator: Huang Guo-qi (黄国琪)

金义成教授儿科推拿学术思想总结

介绍金义成教授儿科推拿学术思想及其临床应用，以促进相关推拿手法的推广应用及老中医经验传承，提高推拿治疗小儿疾病的临床疗效

推拿; 按摩; 小儿推拿; 名医经验

R244.1 【

】A

23 August 2014/Accepted: 15 October 2014

Author: Chen Zhi-wei, master of medicine, associate chief physician. chenzw2005@163.com