| Tuina is both an ancient and new science: ancient for its history of several thousand years; new because there are many mysteries and mechanisms still to be discovered. Manipulation has been improved nearly to the point of being perfect for man's thousands of years' continuing efforts in digging out its potentials, creating new manipulations and exploring its rations. The effect of manipulations, i.e., the quantity of manipulations, mainly depends on the frequency, the technique and the force. During the operation, what the patient feels most is the manipulative force existing between the operator and the skin of the patient. Therefore, its effect mainly depends on the manipulative force while the illustration of manipulative force is nothing but conjecture, without any practical statistics or conclusions.Most current illustrations on manipulative force are just guesswork. What the patient feels most is the manipulative force and its effect mainly depends on the operator's rational use of the manipulative force while how to use rationally depends on the operator's experience. According to Chinese medical theory, the basic requirement for manipulations is durable, forceful, regular, gentle and penetrable. Then manipulative force can be rated grade I-IV according to its amount. For the Tuina therapy, whatever the disease, the guideline is from gentleness to forcefulness, from the lower grade to the higher grade, with variations in force and scope for different parts. Some operators have divided the techniques according to the needs of the six layers of human body, namely, skin, pulse, muscle, vein, bone, and internal organs: gentle force for the external layer while forceful force for the internal layer. Others have divided the manipulations into five types according to the manipulative force and the part it reaches. 1. Gentler Manipulations: the gentler force can only reach such parts as skin and the patient feels relaxed, soft and comfortable. 2. Gentle Manipulations: the gentle force can reach such parts as blood and the patient feels tingle, numb and swell. 3. Intermediate Manipulation: the intermediate force can reach such parts as muscles, which can eliminate convulsion and oppress ache, andthe patient feels severely numb and swell and yet bearable. 4. Forceful Manipulation: the forceful force may reach such internal parts as bone or internal organs, which can stimulate the nerves and invigorate the movement of the internal organs, and the patient clearly feels numb and swell as if being electrified. 5. Superforceful Manipulation: the super force or the exclusive force may change the bone joints and make the deformed parts normal. All the inferences mentioned above are based on the theory of Traditional Chinese Medicine and the theory of dynamics.The study of manipulative force moved a step forward with the introduction of modern instruments. The TDZ-I Tuina manipulation dynamic measuring instrument invented by Shandong University of Traditional Chinese Medicine and Shangdong Academy of Industries in early 1980s initially used the sensors, which was made on the basis of resistance strain technology, to experiment on the pushing-rolling dynamics, which resulted in the manipulative force information measurement system. This system can measure, display and record such dynamic parameters as the manipulati force on the vertical, parallel and intermediate level, the revolving moment of force and its frequency and dynamic wave. It consists of TDL-I Tuina manipulation dynamic measuring instrument, dynamic resistance deformeter for special purpose, SB-14 long-persistence oscilloscope and SC-16 ray oscilloscope. Tuina manipulation dynamic measuring instrument enables pushing-rolling to develop from purely being sensed to being described with dynamic wave of visible multi-dimensional force, thus realizing the objective measurement of manipulation procedure and the objective evaluation of the quality of manipulation, which plays an active role in the study of manipulation dynamics and in the standardization of manipulations. Since then, many studies have been made and based on the first Tuina manipulation dynamic measuring instrument and Tuina experts invented the FZ-I traditional Chinese medicine Tuina manipulative force measuring and analyzing instrument. Employing the instant three-dimensional description of the manipulation force, this new instrument described the characteristics of manipulations from the perspective of dynamics. A series of studies on Dingshi pushing-rolling manipulations analyzed the orbit of its resultant force action point and discovered that its orbit can be divided into four types: Type "Heart", Type "Gourd", Type "8" and Type "Wooden Club". According to the study of the resultant force action point, Type "Heart" and Type "Gourd" results from the correct manipulations and the charts acquired from experienced operators are all in the two types. Afterwards, the group measured and analyzed the frequency domain and the time domain and discovered the following: all the component of force in pushing-rolling varies between 2Hz and 15 Hz, which shows that low frequency force in the Tuina therapy is the main force, reflecting the gentle characteristics of pushing-rolling, and the patient does not feel any extreme force. However, in the frequency spectrum of level force from experienced teachers and doctors appears some 20Hz to 30Hz force, which shows the necessity of somelevel force of high frequency for the successful treatment. According to the study of time domain of action force and the study of wave of vertical action force in pushing-rolling, the vertical action force in pushing-rolling is the main component of force, which increases gradually and decreases gradually after it has reached its maximum while the force remains in the turning point of pushing-rolling internally and externally. In the short period of pushing-rolling internally, the strength remains and then decreases slowly till the end of the cycle. The maximum force from teachers and experts appears earlier than that from students. There is a world of difference for this difference. According to the results of the studies, if the maximum force appears early, the force decreases slowly and regularly and the patients won't feel like being struck; while if the maximum force appears late, the force decreases quickly and irregularly and the patients feel like being struck. From the action force perspective, by employing the Tuina manipulations on the instrument we can only analyzes the waves from the action force, thus verifying the characteristics of dynamics in pushing-rolling. With the traditional Chinese therapy's emphasis on diagnosis and treatment based on an overall analysis of the illness and the patient's condition, we can only discover the connotation of Tuina manipulations by combining Tuina manipulations with the patient's treatment place and its symptoms. The study on the best action force illustrates this. By using the Doppler ultrasonic sound instrument and Tuna Manipulations Dynamic Information measuring and recording system, the writer observes the effects of pushing-rolling, which are of different frequency, different force and different time span, on the blood movements of certain parts in human body. The study shows as follows. The effect of Dingshi pushing-rolling at the frequency of 120 per min on the blood movement around the armpit is greater than that of 60 per min (P< 0.005) and 180 per min (P< 0.05); the effect of 7Kg action force is greater than that of 3Kg (P<0.05) and lOKg (P<0.01); Five-minute Tuina has a greater effect on the blood movement than 2.5-minute's (P<0.005) while there is no difference when compared with ten-minute's. According to the statistics of the experiment, the best frequency of the Dingshi pushmg-rolling is around 120 per minute; the most suitable action force 7KG and the most suitable time 5 minute. The study also shows that prolonged treatment cannot improve the effect.As people come to know more and more about natural therapy, such as no-medicine treatment and no-trauma treatment, Tuina has a brighter and brighter future. In the 21th century, people realized the side effects of medicine treatment and many western countries have begun to seek low-side-effect treatment. More and more people are beginning to have some knowledge on Tuina for its unique technique, effective treatment and no side effects. Tuina has wide connotation and is closely related to various kinds of diseases belong to departments of internal medicine, external medicine, gynecology and pediatrics. The diagnosis and treatment of traditional Chinese medicine is based on its principles while the treatment after thediagnosis is mainly based on experience. Little knowledge of and attention to the quantity of manipulation often leads to confusion in the clinical practice. The manipulative force that the operator imposes on the patient's skin can best bridge the gap. The study of the most suitable action force is one of the best examples. On one hand, the choice of 3kg, 7Kg and lOKg in the pushing-rolling manipulation is rather personal and how much the exact amount of the most suitable action force is is still a mystery. On the other hand, 7Kg is the most suitable action force among the three choices; whether the most suitable action force is more or less than 7Kg is the real significance in studying the manipulation action force.By employing pressure sensor for special purpose, the writer has measured the parameter of the action force existing between the operator and the patient's skin. Its main significance for the exact quantity of Tuina manipulations and clinical practice is listed in the following six aspects.1. The writer measured the maximum pressure, average pressure, action force and the parameter of the manipulative force that the operator imposes on the patient's skin which were all got under different breathing condition and the operator pressed with one palm or two. In general, the pressure from the skilled and beginners shows the same trend, i.e. the pressure is stronger when it is not struck than that when it is. However, there is no much difference concerned with the peak pressure from beginners, no matter pressing with one or both palms, which illustrates that beginners fail to grasp the use of skill force. During the period of inspiration and expiration, for the skilled, the peak pressure during expiration is stronger than that during inspiration, with a difference of 5.5 Kg; while for beginners, the peak pressure during inspiration is stronger than that during expiration, with a difference of 5.5 Kg. All these shows that the skilled can adjust the scope of manipulation force according to different manipulations and different patients while beginners fail to make such a change, which accounts for the fact that peak pressure is almost the same. Therefore, the writer concludes that it is safer to operate under the condition of inspiration.2. The writer measured the parameter of dhyana-thumb-pushing, pressing with thumb, pointing, grasping with two fingers under different conditions, which shows that their maximum pressure is close to one another, ranging between 243.994 mmHg and 244.169 mmHg. The writer explores the reinforcement and reduction of manipulations from the perspective of dynamics.3. The writer measured the parameter of thrusting-wrenching and rotation-wrenching of the neck and lumbar vertebra. The experiment shows that the Kakz sound in both sides of the neck and lumbar vertebra is not directly linked with the maximum thrusting-wrenching force of the thumb.4. The writer measured the parameter of pushing-rolling at different periods and analyzed from the perspective of dynamics the theory of operating force whileemploying pushing-rolling correctly.5. By studying the action force of Tuina manipulations, the thesis discovers the most suitable action force the operator imposes on the skin of the patient, rendering a scientific explanation of such traditional Tuina sayings as "skillful force, gentle strength" and "pressing and brief intermion and go on" with modern language.6. The writer measured the differences of the maximum thrusting-wrenching force the thumb imposes on the spinous process during the rotation-wrenching of the neck and lumbar vertebra, which provides the basis for the exact quantity of Tuina manipulations. The experiment shows that there is no difference concerned with the maximum thrusting-wrenching force in the same side of the neck and lumbar vertebra and the Kakz sound is not directly linked with the maximum thrusting-wrenching force of the thumb.
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