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Touch is a Two-Way Exchange

Tuina (Massage) Therapy Therapeutic Exercise

This article was previously published in the North American Journal of Oriental Medicine (NAJOM). It is reprinted here with the kind permission of NAJOM.

I have contact with many students due to my teaching responsibilities at an acupuncture college in the US (NUNM’s School of Classical Chinese Medicine in Portland, Oregon). Our students learn in their various classes to assess patients. They work to develop their senses—sight, hearing, smell, and touch. It is touch I want to talk about in this article.

It is easy to fall into the mistaken assumption that when we touch our patients, we are just trying to get the sorts of information we have learned are significant in acupuncture. This might be the presence of nodulations, cold areas, patches of dry skin, lack of tone in the tissues, and so on. What students often miss is that they are also at the same time communicating to the patient. Palpation is not a one-way street. Patients can learn a lot about the person touching them if they pay attention to the quality of the touch.

I tell our students that they will be exposed by the quality of their touch. The patients will perceive if they have practiced or not, if they are present and focused or not. They will perceive either confidence or uncertainty, either competence or the lack thereof, and whether or not we are working from a place of compassion. It is a surprising insight for most of the students, and it intimidates them a bit to recognize that they cannot hide their level of skill and practice when they touch someone.

We teach our students to take good care of their hands, to wear gloves when they wash dishes, to not engage in activities that produce callouses, and so on. Many of them take this to heart. Iwashina Anryu Sensei (aka Dr. Bear) gave me this advice 6-7 years ago, and I have followed it faithfully ever since. My hands, and by extension, my patients, have really benefitted.

Dan Bensky is a famous scholar of Chinese medicine in the US and a truly outstanding practitioner. His books (with various coauthors) are our standard reference books in the US. As an osteopath he is well aware, scientifically speaking, of the various parts of the nervous system. In one lecture he shared his idea that he feels it is through our proprioceptive nervous system that we can perceive a phenomenon as subtle as qi. It is my understanding that approximately 70% of the proprioceptive receptors in our hands are in the joint spaces. If the muscles in our hands are clenched and tight, these receptors will not function optimally, meaning we will not accurately assess the quality and movement of the qi. This is an argument for relaxed hands. Really relaxed. Personally I think Dan Bensky is correct about this.

I have felt the hands of Shudo sensei, Kobayashi sensei (of the Shakujyu style), and of Dr. Bear. They are all quite remarkable, truly soft and perceptive on a level that impresses. They are unnaturally soft and exhibit what some refer to as an “informed touch” or an “embodied touch.” I am glad I have had the chance to feel their hands because it gives me a sense of where I want to head.

There is a Taoist bodywork style I have been studying for five years now. It is called qigong tuina (QGTN). The first thing to point out is that it probably should have been named differently, as it is nothing like the typical image of Chinese tuina with its hand and wrist rolling techniques. QGTN involves subtle pulses into the tissues of yin (compressive force) and yang (lengthening force). 

There is a QGTN warm-up activity that is often used that I’d like to share with you, because it has helped my hands so much in my goal of becoming more perceptive in my touch. It involves opening and closing laogong in the palm of the hand. By “open” I do not mean imagining or visualizing something; I mean the actual lengthening and compressing of the hand tissues. We expand the relaxed hand outward from laogong thereby the tissues and joints of the hand, and we follow this with a compressive phase, shrinking back into laogong. There is a slight cupping of the hand as we shorten in this way, and when we lengthen (i.e., open laogong), our hand and fingers straighten again. We continue to do this for 5-10 minutes. This simple activity has made such profound changes in my hands that it would be hard to express. My skin is now so much softer, even from ten minutes a day of this exercise. I place my hands together in prayer fashion to do this exercise, but it can also be done while standing in a qigong universe stance.

A few months ago in one video from a famous Feldenkrais-style practitioner I became aware that Moshe Feldenkrais had his students do essentially the same exercise as a way of developing their hands. I am certain he did not know of QGTN. This confirmed for me the value of this simple little exercise.

This idea I shared above of palpation being a two-way street is really by the way a corollary of Dr. Shudo’s oft-repeated phrase that “our acupuncture shows who we are.” If we only know to press strongly looking for tender points, then that will betray our beliefs and our skill level. We think we are looking for information, but we are communicating information at the same time, maybe some things about us we wish we were not communicating.

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