A variety of skillful movements applied by the hand or other parts to specific acupoints and areas on the hand and foot are called massage maneuvers. Beginners may gradually learn and master these techniques by following the requirements or correct application and manipulation.

The basic requirements for successful application are persistence, forcefulness, evenness, and gentleness. Pressure should be applied deep enough to achieve the objective of functional adjustment. As persistence is essential, the maneuvers should be applied persistently for a period of time depending on therapeutic requirement. Manipulation with repeated intermissions and pauses cannot produce the proper effect. Therefore, beginners should constantly practice and do physical exercise to improve their force, skill, and persistence. The maneuvers should be applied with the fight amount of force, otherwise the manipulation cannot produce the proper effect. At the same time, the force applied to the hand or foot should be modified according to the nature of the disease and the function of the acupoints and areas, because a fixed strong stimulation without correspondent modification may cause damage to the local tissue. The maneuvers should be evenly and rhythmically applied, with a stable frequency and coordinated force to producing a comfortable feeling and a sedative effect and securing the patient's cooperation. An irregular application of maneuvers with force and frequency changed in a disorderly manner from time to time may produce a bad feeling, annoy the patient, and reduce the therapeutic effect. Even application of maneuvers can be achieved after the beginner has learned how to persistently and forcefully apply them. The manipulation should be gentle, not violent, and changes should be smooth with the intensity of stimulation adequate for applying coordinated, continuous, and orderly massage. In brief, the techniques for persistently, forcibly, evenly, and gently applying maneuvers can be learned and mastered after careful trials and untiring practice.

The maneuvers usually applied in hand and foot massage including pressing, digit-pressing, pushing, pinching, twisting, rotating, pulling, rubbing, grinding and stepping maneuvers may be selected in accordance with the condition of patient and the nature of the disease.

1. Pressing maneuver:

Manipulation: The tip or pad of thumb (sometimes sup-ported by another hand or applied by tip of elbow) is used to vertically apply pressure to the body surface. The finger should be firmly applied to the acupoint or area without any shift in location to avoid causing rubbing damage to the skin. The pres-sure should be gradually increased without any violent fluctuation. The frequency of vibration and the force applied to the acupoints or areas should be even (Fig. 3-1).

There are some modifications of the pressing maneuver, such as the simultaneous application of pressure by both hands or by one hand with the support of the other hand. No matter how this maneuver is modified, the requirements of therapy are more important than the elegance of movement.

Indications: The pressing maneuver is usually applied to the acupoints or areas on a fiat part of the hand or foot to deliver deep pressure without hindering or interfering with the nearby or underlying bones. It can be used with a kneading maneuver in combination. This maneuver can be used to treat continuous dull pain anyplace on the body and chronic diseases, and to maintain health.

2. Digit-pressing maneuver:

Manipulation: The tip or knuckle of thumb and the proximal knuckle of index finger may be used to apply a pressure to the acupoints or areas in a more limited space and with a heavier force to produce a stronger stimulation than in the pressing maneuver. The acupoints for applying pressure must be accurately located without any shift from the correct location through the manipulation, and the strength applied to the acupoints may fluctuate over a wide range (Fig. 3-2)

Fig. 3-2 Digit-pressing maneuver

There are some modifications of the digit-pressing maneuver. For example, a rubber finger glove is put on the index finger and its proximal knuckle is used to apply this maneuver; the tip and lateral border of little finger may also be used to apply pressure while it is supported by the thumb and ring finger.

Indications: Digit-pressing is usually applied more forcibly to the fissures of the bones or to more limited spots. It is often used to treat acute or painful diseases.

3. Kneading maneuver:

Manipulation: This maneuver can be divided into finger-kneading and palm-kneading methods. In the finger-kneading maneuver, the pad of the finger is put steadily on the acupoints

Fig. 3-3 Kneading maneuver

or areas with the wrist relaxed, and then the forearm is repeatedly swayed to and fro, with the elbow as a fulcrum, to gently and slowly sway and rotate the wrist and palm to conduct the rotating force to the finger. In the palm-kneading maneuver, the the-nar and hypothenar prominences or the root of the palm are put over the acupoints or areas for a similar swaying and rotating movement by the forearm. This maneuver should be performed gently and rhythmically (Fig. 3-3).

There are some modified methods for doing the kneading maneuver such as using several fingers placed side by side, or with the two palms placed face to face. However, the finger(s) or palm(s) must be placed steadily on the acupoints or areas to gently and persistently apply this maneuver for a longer period of time.

Indications: The kneading maneuver should be applied to the acupoints or areas superficially distributed on a flat and wide region to produce an adjusting and tonic effect. It may be used to treat chronic and deficient diseases, tissue strain, and local swelling and pain. It is also useful for maintaining health.

4. Pushing maneuver:

Manipulation: The pad of a single finger or multiple fingers, and the thenar and hypothenar prominences or the root of palm may be placed at certain points on the hand or foot to perform one directional and linear movement over the skin. The finger or palm should be placed steadily on the skin and a stable pressure applied to reach the tissue layer at a fixed depth for pushing with a slow and even speed (Fig. 3-4).

The pushing maneuver is usually applied along the direc-

Fig. 3-4 Pushing maneuver

tion of the bones with a force adjusted according to therapeutic requirements. If the pushing maneuver is applied across the bones, the force should be applied to a depth not beyond the most superficial bone, and this force should not be very strong, otherwise the finger or palm will meet resistance, the therapeutic effect may be reduced, and the skin and underlying tissue may be injured.

Indications : The pushing maneuver is usually applied along the longitudinal direction of the fingers and palm or along various sides of the fingers. It is used to treat chronic diseases, suffering due to strain, continuous dull pain and deficient and cold diseases. It is also useful for maintaining health. After application of the pushing maneuver for a period of time, it may be replaced by the rubbing maneuver.

5. Pinching maneuver:

Manipulation: The pinching maneuver is a strong simulating method applied with the tip of thumb and the radial border of the thumbnail to the sensitive acupoints or areas; or applied with the thumbnail edge on one side and the nail edges of the fingers on the other side to apply opposite pressure from both sides. The pinching pressure should be gradually increased to reach the deep tissue and produce a strong stimulating sensation, but the skin should be protected from injury caused by the nails. The pinching maneuver should be applied for a short time and

Fig. 3-5 Pinching maneuver at Yongquan (KI 1) acupoint

any discomfort produced by this maneuver can be relieved by the gentle local kneading maneuver. The skin may be damaged if the pinching maneuver is not applied stably with the nails repeatedly slided away from the acupoints (Fig. 3-5).

The tips of both thumbs may be used to employ the opposite pinching maneuver instead of using the nails. The pinching pressure is held for half a minute after it reaches the proper

depth, and then the acupoint or area is gently kneaded for half a

minute after the pressure is released. The manipulation may be

repeated several times, and the pinching maneuver may be ap-

plied at a quicker rhythm.

Indications: The pinching maneuver is usually applied at

the fingers and toes, at the narrow joint spaces of the fingers

and toes, and at the metacarphalangeal joints. It may be used in

combination with pressing, kneading and twisting maneuvers to

treat acute diseases, pain, psychosis, and neurasthenia.

6. Twisting maneuver:

Fig. 3-6 Twisting maneuver

Manipulation: In general, the fingers or toes are held by the pads of the thumb and index finger and twisted to and fro for a certain length of time. The movement should be quick, smooth, and nimble, without intermission or interruption (Fig. 3-6).

Quick movement is the important requirement for this method, otherwise a slow movement is the kneading maneuver with opposite pads of fingers rather than the twisting maneuver. The manipulation should not be superficial even though it is applied gently; and it should not be sluggish, even if applied forcibly.

Indications: The twisting maneuver is usually applied to fingers, toes, and small joints for treating chronic diseases and local discomfort, and also used to maintain health. It is often in combination with the pinching and pushing maneuvers.

7. Rotating maneuver:

Fig. 3-7 Rotating maneuver

Manipulation: The fingers, toes, wrist, and ankle joints are passively moved in an even, circular rotation. The movement should be gentle, forcible and stable. The range of movement is increased while the speed is decreased until the range of rotation reaches its normal limitation of movement; then the range is gradually decreased and the speed is gradually increased. The movement should be smooth and flexible, and not sluggish or interrupted (Fig. 3-7).

The rotating maneuver can relax and adjust the joints and facilitate their movement. For convenient, safe, flexible and reliable application of this maneuver it can be performed by both hands, one hand for fixation and the other hand for rotation. The rotation should not be applied violently in one direction because this may injure the joint.

Indications: This maneuver is usually applied to the fingers, toes, wrist, and ankle joints to maintain and improve their mobility; and it can also prevent diseases and slow the aging process. It can be used to treat chronic diseases, senile diseases, local injury, and pain. Before applying this maneuver, the joints should be relaxed by pulling and twisting maneuvers to avoid damaging them.

8. Pulling maneuver:

Manipulation: This is a maneuver to quickly and evenly apply traction to one end of the finger, toe, wrist or ankle joint while the other end is fixed. The movement should be nimble and coordinated, but not violent or rough; it is always done along the longitudinal axis of the joint, but not inclined to one side, otherwise the joint and its ligaments may be injured (Fig.3-8).

Fig. 3-8 Pulling maneuver

This is a good method to relax the joint, but the click produced in the joint by pulling should not be intentionally induced, because doing this repeatedly may certainly injure the joint.

Indications: This maneuver is applied to the wrist, ankle, interphalangeal, metacarpophalangeal or metatarsophalangeal joints to relax the joints and improve their movement; it can also improve health and slow the aging process. This method can be used to treat senile diseases, local diseases of the joint, and maintain health. It also can be used in combination with the twisting and kneading maneuvers.

9. Rubbing maneuver:

Manipulation: The finger, thenar and/or hypothenar prominence or root of the palm is firmly put at a certain part of the hand or foot to do quick linear movement. To apply the rubbing

Fig. 3-9 Rubbing maneuver

maneuver, the wrist joint should be naturally extended, the forearm in a horizontal position, the finger, thenar and/or hypothenar prominence or root of palm pressed downward over the skin, and the upper ann repeatedly moved backward and forward with the shoulder joint as its axis. For the finger-rubbing maneuver, the wrist or metacarpophalangeal joint may be used as the axis instead. The to and fro linear movement should be quickly and continuously performed without interruption to produce a hot sensation (Fig. 3-9).

The rubbing maneuver with a gentle, but not very superficial pressure and a quick rhythm can produce a good effect to promote circulation of qi and blood, relieve stagnation in meridians, expel cold pathogen, and warm and tone the body. The constant rubbing maneuver applied to the sole may particularly produce a marked effect to tone essence and bone marrow, pre-vent and cure diseases, slow the aging process, and prolong lifes.

Indication: The rubbing maneuver is better to be applied along the bones of the hand and foot, especially on the palm of the hand and sole of the foot to treat chronic diseases, deficient and cold diseases, and mental diseases; and it is also useful for maintaining health and strengthening the body. It also can be used in combination with other maneuvers.

10. Grinding maneuver:

Manipulation: The palm or the pads of index, middle and ring fingers is placed at a certain acupoint on the hand or foot and the wrist joint and arm are swayed to bring the palm or finger pads into a clockwise or counterclockwise circular move-

Fig. 3-10 Grinding maneuver

ment, just like grinding a Chinese ink bar. The cycles of the grinding movement may be gradually increased in diameter centrifugally from the center to the peripheral area, and then gradually reduced in diameter centripetally to the center to produce a hot sensation over this area. The movement should be gentle, the velocity even and coordinated, and the rhythm quick. The pressure of the grinding movement may be gradually and slightly increased, but the quick rhythm should be maintained (Fig. 3-10).

The grinding maneuver is similar to the rubbing maneuver, warming the meridians and removing their stagnation to promote circulation of qi and blood. The grinding movement should be done quickly at an even speed, and the pressure should be maintained to reach a fixed depth. Uneven and sluggish manipulation will not produce the proper effect.

Indications: The grinding maneuver is best performed over a large flat area to treat senile diseases, chronic diseases, and deficient and cold diseases; it is also used to relax local tissue after the heavy grinding maneuver has been applied.

11. Stepping maneuver:

Manipulation: The soles of the patient are stepped upon by the heels or metatarsal and phalangeal part of the physician's

Fig. 3-11 Stepping maneuver

foot with rhythmic vibrations. The vibrating movement should be rhythmic and the pressure should be adequately applied depending on the condition of the patient and the nature of disease. However, the physician should not aoolv his entire weight on the patient. This is a simple and convenient method for applying pressure over a large area and the physician can save their energy. Constant application of this maneuver is very useful for adjusting the functions of the body (Fig. 3-11).

The stepping maneuver can produce stimulation over a larger area on the anterior and middle part of the sole for adjusting bodily functions, relieving fatigue, refreshing mental activity, and opening the orifices of the sense organs. It also can be used to prevent and treat cerebrovascular diseases.

Indications: The stepping maneuver is useful for treating cerebrovascular diseases, neurasthenia, general fatigue, pain, and traumatic injury with pain; and it can also be used for maintaining health and retarding the aging process. This method also can be mutually applied among family members to prevent and treat diseases.

The essential maneuvers for hand and foot massage have been discussed above. Each of them has its specific use, and they can be flexibly selected and used in combination to improve the therapeutic effect.

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