J. Acupunct. Tuina. Sci.

2011, 9 (6): 388-396

DOI: 10.1007/s11726-011-0558-5

Literature Review

Study Progress of Tuina for Insomnia in Recent 10 Years

10
Zhang Ling ()1, Gu Fei ()2
1 Department of Acupuncture and Tuina, Health Service Center of Changshou Community, Putuo District, Shanghai,
Shanghai 200060, P. R. China
2 Department of Tuina, Yue Yang Hospital of Integrated Chinese and Western Medicine Affiliated to Shanghai University
of Traditional Chinese Medicine, Shanghai 200437, P. R. China

R244.1
A
Key WordsInsomnia; Tuina; Massage; Review
Insomnia is a common sleeping disturbance
characterized by difficulty falling asleep and/or
maintaining sleeping. It is a subjective experience
without normal sleeping quality or time[1]. Insomnia is
often manifested by difficulty falling asleep, or easy
wake up, and difficulty to fall asleep again after
waking up, or even sleepless through the night,
similar to neurasthenia and neurosis in modern
medicine[2].
In the recent years, with accelerating life rhythm
and increasing work stress, the population of
insomnia has shown an increasing tendency. Based
upon the reports from the United States Department
of Health and Human Services, about 6 400 000
Americans suffer from insomnia every year[3]. And
the incidence reaches 10%-20% in China[4]. It has
been proved by the overseas studies that the sleeping
problem is often the early risk factor of various
diseases[5-7], such as cardiovascular diseases, diabetes
and depression. The long-term sleeping disturbance
usually harms the physical and mental health[4].
The sedative and hypnotic agent, such as
Benzodiazepine (BDZ), is often used for insomnia in
modern medicine. It can increase the sleeping time
and shorten the sleeping incubation markedly[8], but
can easily induce drug addiction[9], and the incidence
of the recurrence of insomnia is high after withdrawal
and the hangover effect is often obvious in the second
Author: Zhang Ling, Master of Medicine, Resident Doctor,
linda1984@citiz.net
Corresponding Author: Gu Fei, associate chief physician,
tutor for master candidates, gufeiking@163.com

day. So, its damage to the cognitive and psychomotor

function could not be neglected[10]. Tuina as a safe,
effective, and acceptable therapeutic method without
side effects, is appreciated by people[11]. Now, studies
on tuina treatment for insomnia are summarized as
follows.

1 Commonly Used Tuina Manipulations

1.1 Digital acupoint pressure
Digital acupoint pressure is a specific therapy
applied with "finger needle" instead of "filiform
needle" based upon the integration of pattern
identification by the theories of meridians and
Zang-fu organs, and it is upon the theoretical
foundation of "reinforcing-reducing by following or
against the flowing direction of meridians" in
acupuncture. Gao XD[12] treated 116 cases with digital
an-pressing based on the pattern identification, by
selecting the acupoints on the head, such as Yintang
(GV 29), Jingming (BL 1), Cuanzhu (BL 2), Yuyao
(Ex-HN 4), Sibai (ST 2), Touwei (ST 8), Baihui
(GV 20), Sishencong (Ex-HN 1), Jiaosun (TE 20),
Shuaigu (GB 8), Anmian (Extra) and Fengchi (GB
20); and the acupoints on the limbs and body, such as
Shenmen (HT 7), Neiguan (PC 6), Zusanli (ST 36),
Sanyinjiao (SP 6), Zhongwan (CV 12), Qihai (CV 6)
and Guanyuan (CV 4). Xinshu (BL 15), Pishu (BL 20)
Jueyinshu (BL 14) and Weishu (BL 21) were added
for those with heart-spleen deficiency; Shenshu
(BL 23), Mingmen (GV 4), Yongquan (KI 1), Taixi
(KI 3) and Taichong (LR 3) were added for those with
fire hyperactivity due to yin deficiency; Xinshu

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J. Acupunct. Tuina. Sci. 2011, 9 (6): 388-396

(BL 15), Danshu (BL 19), Daling (PC 7) and Qiuxu

(GB 40) were added for those with timidity due to
heart deficiency; Ganshu (BL 18), Xingjian (LR 2),
Taichong (LR 3) and Zuqiaoyin (GB 44) were added
for those with fire derived from liver qi stagnation;
and Pishu (BL 20), Xinshu (BL 15), Weishu (BL 21),
Zusanli (ST 36) and Fenglong (ST 40) were added for
those with internal disturbance by phlegm-heat. The
results showed the total effective rate was 97% in the
patterns of heart-spleen deficiency and fire
hyperactivity due to yin deficiency, and it was 100%
in the patterns of timidity due to heart deficiency, fire
hyperactivity due to yin deficiency, and internal
disturbance by phlegm-heat. Xu M, et al[13] treated 78
cases with relaxing tuina techniques plus digital
acupoint pressure. Firstly, an-pressed Fengchi
(GB 20), Fengfu (GV 16), Yifeng (TE 17) and
Anmian (Extra). Then, stimulated Shenmai (BL 62),
Zhaohai (KI 6) in predominance, namely Zhaohai
(KI 6) (following the Yin Heel Vessel) and Shenmai
(BL 62) (against the Yang Heel Vessel) for severe
insomnia and mild somnolence, and Zhaohai (KI 6)
(against the Yin Heel Vessel) and Shenmai (BL 62)
(following the Yang Heel Vessel) for mild insomnia
and severe somnolence, and then an-pressed
Sishencong (Ex-HN 1), Shenmen (HT 7) and
Sanyinjiao (SP 6) following the meridian. Xinshu
(BL 15) (following the meridian), Shenshu (BL 23)
(against the meridian) were added for heart-spleen
deficiency; Ganshu (BL 18), Xingjian (LR 2) and
Daling (PC 7) (against the meridian) were added for
upward disturbance of the liver fire; Zhongwan
(CV 12), Neiguan (PC 6) and Zusanli (ST 36) (against
the meridian) were added for disharmony of the
stomach; Xinshu (BL 15), Danshu (BL 19) and
Yanglingquan (GB 34) (following the meridian) for qi
deficiency of heart-gallbladder, and Fenglong (ST 40),
Shaofu (HT 8) and Gongsun (SP 4) (following the
meridian) for internal disturbance of phlegm-fire.
After 3-course treatments, the total effective rate was
96.2%. Xue CQ[14] treated 85 cases with tuina and
specific acupoints. Tui-pushing Jiaji (Ex-B 2),
gun-rolling and rou-kneading the Bladder Meridian
on the back, tui-pushing and ca-wiping Shangliao (BL
31), Ciliao (BL 32), Zhongliao (BL 33) and Xialiao
(BL 34), tui-pushing the abdomen and digital
an-pressing Qihai (CV 6), Xuehai (SP 10),
Yinlianguan (SP 9), Sanyinjiao (SP 6), Zusanli

(ST 36), Neiting (ST 44), Zhongwan (CV 12), Lieque

(LU 7), Neiguan (PC 6), Shenmen (HT 7), Danzhong
(CV 17), Rugen (ST 18), Qimen (LR 14), Zhangmen
(LR 13), Zhongfu (LU 1) and Yunmen (LU 2),
opening Tianmen (Extra), tui-pushing Kangong
(Extra), rou-kneading Taiyang (Ex-HN 5), qiapinching Chengjiang (CV 24), an-pressing
Sishencong (Ex-HN 1) and Baihui (GV 20) and
na-grasping Jianjing (GB 21). The total effective rate
was 90.5%.
1.2 Healthcare tuina method
Healthcare tuina method was applied mainly to the
acupoints of yang meridians on the head, as well as
acupoints from the Governor Vessel, Spleen, Stomach
and Bladder Meridians. Manipulations should be light,
slow and gentle to strengthen the brain, calm the mind,
and regulate and harmonize yin and yang. Wang Q[15]
treated 52 cases with healthcare tuina method. After
the patient took a supine position, tui-pushing Yintang
(GV 29) Shenting (GV 24) Baihui (GV 20);
slightly rou-kneading Baihui (GV 20); divergently
tui-pushing Yintang (GV 29) Taiyang (Ex-HN 5),
tui-pushing the orbit with one-thumb, and an-pressing
and rou-kneading Yintang (GV 29) Yingxiang
(LI 20) front of the ears [Yintang (GV 29),
Shenting (GV 24), Cuanzhu (BL 2), Yuyao (Ex-HN 4),
Chengqi (ST 1), Sibai (ST 2), and Taiyang (Ex-HN 5)
in predominance]. Then mo-rubbing manipulation
was applied. An-pressed and rou-kneaded Danzhong
(CV 17), Zhongwan (CV 12), Shenque (CV 8), Qihai
(CV 6) and Guanyuan (CV 4), and mo-rubbed the
abdomen clockwise and rou-kneaded Neiguan (PC 6)
and Zusanli (ST 36). Then with the patient in prone
position, combed the head, swept the two sides of the
head and rou-kneaded Naokong (GB 19) and
na-grasped Fengchi (GB 20) to Jianjing (GB 21), and
by tui-pushed divergently the bilateral Bladder
Meridian and an-pressed and rou-kneaded Xinshu
(BL 15), Geshu (BL 17), Pishu (BL 20), Shenshu
(BL 23), Guanyuanshu (BL 26) and Dachangshu (BL
28) in predominance. Rou-kneading Neiguan (PC 6),
Shenmen (HT 7), Zusanli (ST 36) and Sanyinjiao (SP
6) were added for those with heart-spleen deficiency;
rou-kneading Taichong (LR 3), Taixi (KI 3) and
Zhaohai (KI 6) and ca-wiping Yongquan (KI 1) for
fire hyperactivity due to yin deficiency; rou-kneading
Quchi (LI 11), Hegu (LI 4) and Fenglong (ST 40),
cross ca-wiping upper chest for those with internal

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J. Acupunct. Tuina. Sci. 2011, 9 (1): 388-396

disturbance of phlegm-heat; spine nie-pinching for

those with disorder of the gastrointestinal functions.
After 1-course treatment, sleep was obviously
improved in 67% of the patients. Guo D[16] treated
insomnia with healthcare tuina techniques by
kai-opening Tianmen (Extra), tui-pushing the
forehead divergently, qia-pinching Yuyao (Ex-HN 4),
rou-kneading Taiyang (Ex-HN 5), qia-pinching Sibai
(ST 2) and Jingming (BL 1), digital an-pressing Juliao
(ST 3), tui-pushing Jiache (ST 6), digital an-pressing
Baihui (GV 20), mo-rubbing the five meridians
separately, digital rou-kneading Fengchi (GB 20),
rou-kneading the Conception Vessel, Stomach, Spleen
and Gallbladder Meridians on the chest and abdomen,
and finally na-grasping and rou-kneading the muscles
of the neck. The total effective rate was 98.1%.
1.3 Internal exercise tuina method
Prof. Xia HM is skillful in treating insomnia with
internal exercise tuina method. Focused on holistic
concept, this method has the effects to balance the
liver, strengthen the spleen, harmonize the stomach,
calm the mind, and warm and tonify the kidney[17].
Operation: Tui-pushing Qiaogong (Extra);
tui-pushing the forehead and superciliary arch
divergently; digital an-pressing Jingming (BL 1),
tui-pushing Yingxiang (LI 20), Shuigou (GV 26) and
Chengjiang (CV 24) divergently; an-pressing and
rou-kneading Baihui (GV 20) and Sishencong
(Ex-HN 1); saosan-sweeping method;
na-grasping the five meridians.
For those with liver fire attacking the stomach,
additionally tui-pushing Yintang (GV 29) Shenting
(GV 24) Touwei (ST 8) Taiyang (Ex-HN 5)
superciliary arch Yintang (GV 29) by one-thumb
technique; tui-pushing the orbit by route, and
tui-pushing Jingming (BL 1) Yingxiang (LI 20)
Dicang (ST 4) Jiache (ST 6) Xiaguan (ST 7)
Taiyang (Ex-HN 5) superciliary arch Jingming
(BL 1); digital an-pressing Ganshu (BL 18), Danshu
(BL 19), Pish (BL 20), Weishu (BL 21), Qimen
(LR 14), Zhangmen (LR 13), Taichong (LR 3);
na-grasp Jianjing (GB 21) and cuo-rubbing the
hypochondriac regions.
For those with obstruction of phlegm and blood
stasis, additionally tui-pushing Yintang (GV 29)
Shenting (GV 24) Touwei (ST 8) Taiyang
(Ex-HN 5) superciliary arch Yintang (GV 29)
by one-thumb technique; tui-pushing the orbit by

route, and tui-pushing Jingming (BL 1) Yingxiang

(LI 20) Dicang (ST 4) Jiache (ST 6)
Xiaguan (ST 7) Taiyang (Ex-HN 5) superciliary
arch Jingming (BL 1); an-pressing and
rou-kneading Shenmen (HT 7), Neiguan (PC 6),
Xinshu (BL 15), Geshu (BL 17), Pishu (BL 20),
Fenglong (ST 40), Zusanli (ST 36), Sanyinjiao (SP 6),
and cross ca-wiping Pishu (BL 20), Weishu (BL 21),
Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33)
and Xialiao (BL 34) and the Governor Vessel
straightly.
For those with deficiency of both heart and spleen,
additionally tui-pushing Shangwan (CV 13),
Zhongwan (CV 12), Xiawan (CV 10), Shenque
(CV 8), Qihai (CV 6) and Guanyuan (CV 4) by
one-thumb technique, and zhen-vibrating various
acupoints by the fingers; mo-rubbing the abdomen,
zhen-vibrating the abdomen by the palm, an-pressing
and rou-kneading Tianshu (ST 25), Xinshu (BL 15),
Pishu (BL 20), Zusanli (ST 36), Sanyinjiao (SP 6),
and straightly ca-wiping the Governor Vessel.
For those with fire hyperactivity due to yin
deficiency, additionally na-grasping Jianjing (GB 21),
straightly tui-pushing the Governor Vessel and Foot of
Taiyang Meridian, an-pressing and rou-kneading the
Foot of Taiyang Meridian on the back [Xinshu
(BL 15), Pishu (BL 20), Weishu (BL 21), and Shenshu
(BL 23) in predominance]; kou-tapping the Foot of
Taiyang Meridian on the back; and cross ca-wiping
Shenshu (BL 23) and Shangliao (BL 31), Ciliao
(BL 32), Zhongliao (BL 33) and Xialiao (BL 34).
1.4 One-thumb technique of guiding yang into yin
Based on the inheritance of one-thumb technique of
Mr. Zhu Chunting, a famous tuina master, Zhu
Dingcheng treated 40 elder patients by one-thumb
technique of guiding yang into yin. This technique is
gentle in manual manipulation, small in stimulation
and is especially suitable for those with high age,
weak constitution and anxiety. The technique includes:
Slightly mo-wiping Dazhui (GV 14)
Changqiang (GV 1), spine nie-pinching; one-thumb
tui-pushing or gun-rolling method to excite yang qi.
Tui-push Baihui (GV 20) by thumb-side technique,
and mo-rubbing Yintang (GV 29) by finger;
tui-pushing and rou-kneading Baihui (GV 20), Taiyin
(Extra) and Taiyang (Ex-HN 5) by "double butterfly
flying" method, waiting for and guiding qi several
times, till the patient has a sleeping sensation.

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Tui-pushing Shangjingming (Extra) and the upper and

lower orbital ridge by thumb-side technique,
mo-wiping the forehead and head divergently.
repeat step . After 3-5 courses of treatment, the
total effective rate was 80%[18]. Based upon routine
medications, Zhou J[19] treated 60 cases with
one-thumb technique of guiding yang into yin. Before
going to bed, the patients took 0.4 mg Alprazolam
orally. The technique of guiding yang into yin was as
same as before. After two courses, the scores in
various items were obviously better in the tuina group
(tuina plus oral administration of Alprazolam) than
that in the control group (single oral administration of
Aprazolam) (P<0.05), with remarkable improvement
in syndrome of dependence on sleeping pills
(P<0.01).
1.5 Foot massage method
By stimulation to the reflex areas of foot, foot
massage method is supposed to regulate the
physiological functions and enhance the immune
functions of the human body, to realize the purposes
of preventing diseases, treating diseases, and
strengthening the body constitution. Yin HN, et al[20]
treated insomnia mainly with massage on the reflex
areas of foot, predominantly by heart, liver, spleen,
kidney, cerebrum, cerebellum, frontal sinus, pituitary,
and insomnia, assisted by the endocrine, immune and
circulatory systems, and by an-pressing and roukneading Yintang (GV 29), Baihui (GV 20), Shenting
(GV 24), Fengchi (GB 20), Anmian (Extra), Neiguan
(PC 6), Shenmen (HT 7), Zusanli (ST 36), Sanyinjiao
(SP 6) (tonifying technique) in body acupoints. After
the treatments for 2-3 courses, the total effective rate
was 79.6%[20]. Ye T[21]treated 41 cases with massage
on the reflex areas of foot plus moxibustion on
Yongquan (KI 1), focusing on heart, liver, spleen,
kidney, insomnia, adrenal, and thyroid gland of the
foot, plus suspended moxibustion on Yongquan (KI 1)
for 20-30 min. The results showed the total effective
rate was 93%. Zhang RC[22] treated 36 cases with
massage on the head and face plus foot reflex areas,
by pushing Yintang (GV 29) on the head, by
an-pressing and rou-kneading Cuanzhu (BL 2),
Yangbai (GB 14), Sizhukong (TE 23), Taiyang
(Ex-HN 5), Tinggong (SI 19), Tinghui ( GB 2), Jiache
(ST 6), Daying (ST 5), Dicang (ST 4), Quanliao (SI
18), Sibai (ST 2), and Jingming (BL 1) with
one-thumb technique in "" shape, and by

rou-kneading Taiyang (Ex-HN 5) Tinghui (GB 2)

divergently with two hands, and by rou-kneading the
forehead and face with the large thenar, and
an-pressing the reflex areas of the abdominal nerve
plexus, trigeminal nerve, cerebrum, brain stem,
shoulder joint, heart, adrenal, kidney, spleen and lung
in predominance, for 15-42 sessions. The total
effective rate was 94%.
1.6 "Heaven-Earth-Person" tuina method
"Heaven-Earth-Person" tuina method is supposed
to operate on the three regions of "Heaven", "Earth"
and "Person" of the human body, namely "upper
(head region)", "middle (abdomen and back region)"
and "lower (foot region)". It bases upon the holistic
viewpoint of "correspondence between man and
universe", and with integration of the meridian, the
Zang-fu organs and the reflexion theories organically.
The procedure of operation: When herbal decoction
is used for soaking the feet, first the head and face are
massaged. For massage on the head and face
(heaven region), it is advisable to open Tianmen
(Extra), divergently in yin and yang, and press and
knead the acupoints on the forehead and around the
orbit; to push by one-thumb technique or press by the
finger the acupoints on the head, and to sweep the five
meridians, grasp the five meridians and tap the vertex,
and pinch and grasp the neck. On the foot region
(earth region), first routine massage is applied to the
foot. When the reflex areas are massaged, it is
advisable to an-press and rou-knead the reflex areas
of cerebrum, cerebellum, frontal sinus, heart, spleen,
liver, kidney and insomnia in predominance. On
the abdomen and back (person region), it is advisable
to an-press and rou-knead the lumbar region and back
by the palm first, and then to an-press and rou-knead
by the fingers, gun-roll, and tui-push by one-thumb
technique on the first lateral line of the Bladder
Meridian, on Xinshu (BL 15), Ganshu (BL 18), Pishu
(BL 20), Weishu (BL 21) and Shenshu (BL 23) in
predominance, and then to tui-push Jiaji (Ex-B 2),
nie-pinch, na-grasp, pai-tap and kou-knock the
lumbar region and back, and finally to an-press,
rou-knead, nie-pinch and na-grasp the abdomen,
mo-rub and zhen-vibrate the abdomen. Hu ZB[23]
treated 60 cases with "Heaven-Earth-Person" method.
After the treatment, Pittsburgh sleep quality index
(PSQI) and most part of integral quantity of
traditional Chinese medicine symptoms were

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J. Acupunct. Tuina. Sci. 2011, 9 (1): 388-396

obviously decreased in the patients, and there were

statistic differences between before and after
treatments.
1.7 Three-step tuina method
Three-step tuina method is different from
"Heaven-Earth-Person" tuina method. In the former,
tuina is applied to "Heaven", "Earth" and "Person"
regions, namely in three regions of "head", "back and
abdomen" and "foot". In the latter, the head, abdomen
and back are taken as the areas for treatment. The
procedure of operation is as follows.
Head area: To na-grasp the two sides of the head,
an-press and rou-knead Yintang (GV 29), tui-push
Yintang (GV 29) toward Shenting (GV 24), an-press
Qianting (Extra) toward Baihui (GV 20); zhen-vibrate
Baihui (GV 20) with the fingers, tui-push the forehead
and the superciliary arch divergently toward Taiyang
(Ex-HN 5), zhen-vibrate Taiyang (Ex-HN 5) with the
fingers, pai-tap the head and zhen-vibrate the two
temples and vertex by the palm.
Abdominal area: To mo-rub the abdomen with the
palm, an-press and rou-knead or tui-push Zhongwan
(CV 12), Shenque (CV 8), Qihai (CV 6), and
Guanyuan (CV 4) by one-thumb technique, and
zhen-vibrate various acupoints by the fingers; tui-push
from the center toward the two bilateral sided with
two palms, from the ribs downward to the symphysis
pubis, and zhen-vibrate the abdomen with the palm.
Back area: To na-grasp Jianjing (GB 21), tui-push
the Governor Vessel and the Bladder Meridian
vertically, an-press and rou-knead Xinshu (BL 15),
Pishu (BL 20), Weishu (BL 21) and Shenshu (BL 23),
and slightly pai-tap the Bladder Meridian.
Zhou YF, et al[24] treated 84 cases in pattern of
heart-pleen deficiency by the three-step method. The
total effective rate was 96.4%.
1.8 Two-Step tuina method
Lv M, et al[25] treated insomnia with two-step
method, by tonifying technique in predominance, plus
the dredging technique. The first step is supposed to
tui-push by thumb side Yintang (GV 29) Shenting
(GV 24), Yintang (GV 29) Taiyang (Ex-HN 5) and
the orbital area, back and forth; an-press and
rou-knead Yintang (Extra), Shenting (GV 24),
Cuanzhu (BL 2), Taiyang (Ex-HN 5), Jingming
(BL 1), Xinshu (BL 15), Ganshu (BL 18), Pishu
(BL 20), and Weishu (BL 21), and apply the
saosan-sweeping technique, na-grasp the five

meridians, Fengchi (GB 20) and Jianjing (GB 21).

The second step is supposed to mo-rub the abdomen
clockwise, an-press and rou-knead Zhongwan
(CV 12), Guanyuan (CV 4), and Zusanli (ST 36).
After the treatment, 46 cases got clinical cure, 23
cases got remarkable effect, 7 cases got effect, and 0
case of failure.
1.9 Zi Wu Liu Zhu (Midnight-noon Ebb-flow)
acupoint-opening tuina method
Zi Wu Liu Zhu (Midnight-noon Ebb-flow)
acupoint-opening tuina method is supposed to apply
tuina, after the flowing condition of qi and blood and
the opening and closing time of the acupoints of that
day are calculated in accordance with the theory of Zi
Wu Liu Zhu (Midnight-noon Ebb-flow). Zhang HD,
et al[26] treated 31 cases with Zi Wu Liu Zhu
(Midnight-noon Ebb-flow) acupoint-opening tuina
method, by giving the treatment at the
acupoint-opening period of Earthly Branch 9 and
Earthly Branch 10 (15:00 to 17:00 and 17:00 to
19:00), and by an-pressing and tui-pushing Zhiyin
(BL 67), Fuliu (KI 7), Tonggu (KI 20), Yingu (KI 10),
Jinggu (BL 64) and Taixi (KI 3) for correcting
deficiency, and by tui-pushing them in opposite
direction to reduce its excess. After two courses, the
total effective rate was 93.5%.
1.10 Method of strengthening the spleen and
calming the mind
The method of strengthening the spleen and
calming the mind is mainly applied to the abdomen,
by selecting the acupoints on the abdomen in
predominance and the acupoints on the head in
addition, for directly regulating the functions of the
heart, spleen and brain, which are closely related to
insomnia, by producing good stimulation to balance
yin and yang, strengthen the spleen and calm the mind.
The techniques are supposed to mo-rub the abdomen
and dan tian, rou-knead the abdomen, tui-push the
abdomen divergently, an-press and rou-knead
Shangwan (CV 13), Zhongwan (CV 12), Xiawan (CV
10), Guanyuan (CV 4), Qihai (CV 6) and Zusanli (ST
36), and an-press and rou-knead Baihui (GV 20),
Sishencong (Ex-HN 1), Taiyang (Ex-HN 5), and
Anmian (Extra). Liu P, et al[27] treated 30 cases in
pattern of heart and spleen deficiency by this method.
The total effective rate was 96.7%.

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1.11 Method of regulating Wei-Defensive qi and

soothing liver
Method of regulating Wei-Defensive qi and
soothing liver is supposed to apply massage on the
Yin and Yang Heel Vessels in predominance, for
regulating the Yin and Yang Heel Vessels and
communicating with yin and yang.
Operation: To tui-push Yintang (GV 29)
Shenting (GV 24), Yintang (GV 29) the end of
eyebrow, an-press and rou-knead Baihui (GV 20) and
Fengchi (GB 20), and na-grasp the five meridians.
To gun-roll and heavily tui-push the lateral side of the
thigh (against Yang Heel Vessel), gun-roll and slightly
tui-push the medial side of the thigh (following Yang
Heel Vessel), an-press and rou-knead Shenmai
(BL 62), Zhaohai (KI 6), Jiaoxin (KI 8) and Fuyang
(BL 59). To ca-wipe the Bladder Meridian on the
back perpendicularly. To tui-push Tiantu (CV 22)
Qihai (CV 6), an-press and rou-knead Danzhong
(CV 17), Zhongwan (CV 12) and Qihai (CV 6),
cuo-rub the ribs, round mo-rub the abdomen, and
an-press and rou-knead Zusanli (ST 36), Fenglong
(ST 40) and Taichong (LR 3).
Yan XH[28] treated 28 cases in pattern of internal
disturbance by phlegm and heat with this method. The
total effective rate was 92.9%.
1.12 Tuina plus herbal medicine
Zhou LQ[29] treated 39 cases of intractable
insomnia with tuina plus modified Suan Zao Ren
Decoction, with tuina applied mainly to the neck,
shoulder, back, head and face. The herbal formula
was modified based upon the basic formula in
accordance with the symptoms. The total effective
rate was 89.7%. Liu KL[30] treated 12 cases of
intractable insomnia with tuina plus oral
administration of Xue Fu Zhu Yu decoction.
Tui-pushing,
mo-wiping,
an-pressing
and
rou-kneading the acupoints on the head and face,
saosan-sweeping technique, na-grasping the five
meridians, Fengchi (GB 20) and Jianjing (GB 21)
were used. The total effective rate was 91.7%.
1.13 Tuina plus acupuncture
Xu M[31] treated 68 cases with tuina plus
acupuncture. The techniques including tui-pushing,
rou-kneading and an-press the Bladder Meridian, and
mo-rubbing, tui-pushing, rou-kneading and zhenvibrating the abdomen, and an-pressing Cuanzhu
(BL 2), Yuyao (Ex-HN 4), Jiaosun (TE 20), Baihui

(GV 20), Yintang (GV 29) and Ashi points next to

Yuzhen (BL 9). Afterward, Sishencong (Ex-HN 1),
Shenmen (HT 7) and Sanyinjiao (SP 6) were
punctured. After the treatment for 1-3 courses, the
total effective rate was 97.0%. Jia DD, et al[32] treated
36 cases with tuina on the head and face, plus foot
massage and acupuncture. Routine tuina techniques
were applied to the head and face. Foot massage was
mainly applied to the reflex areas of kidney, bladder,
head, liver and abdominal nerve. In accordance with
the patients situation, Xinshu (BL 15), Ganshu
(BL 18), Pishu (BL 20) and Shenshu (BL 23) were
added for those with heart-spleen deficiency;
Sanyinjiao (SP 6), Taixi (KI 3), Xinshu (BL 15) and
Shenshu (BL 23) were added for those with
disharmony between the heart and kidney. After
3-course treatments, the total effective rate was
85.8%.
1.14 Others
Huang MB[33] treated 46 cases in pattern of fire
hyperactivity due to yin deficiency with massage
techniques. First, after the patient took a prone
position, the massage was applied from the shoulder
to the heel, by rou-kneading the back and lumbar
region, an-pressing Xinshu (BL 15), Ganshu (BL 18)
and Shenshu (BL 23), and rou-kneading Jiaji (Ex-B 2),
and then in the supine position, by mo-wiping Yintang
(GV 29) toward Shenting (GV 24), digital an-pressing
Shenting (GV 24); tui-pushing the superciliary arch
divergently toward the forehead; an-pressing the five
meridians of the head; rou-kneading Taiyang
(Ex-HN 5), Jiaosun (TE 20) and the route of the
Gallbladder Meridian on the head, and digital
an-pressing and rou-kneading the lower border of the
occipital bone, Tianzhu (BL 10), Fengchi (GB 20) and
Wangu (GB 12); rou-kneading the abdomen and
digital an-pressing Qimen (LR 14), and bo-plucking
and rou-kneading the route of the Kidney Meridian at
the medial side of the lower limb, and digital
an-pressing Taixi (KI 3), Taichong (LR 3), Zhubin
(KI 9) and Sanyinjiao (SP 6); and an-pressing the
route of the Pericardium Meridian on the forearm and
digital an-pressing Shenmen (HT 7) and Neiguan
(PC 6). The results showed the total effective was
95.7%. Zeng R, et al[34] treated 38 cases with tuina
plus auricular sticking method, by using ear points of
Shenmen (TF4), Sympathetic (AH6a), Endocrine
(CO18), Subcortex (AT4), Heart (CO15), Liver (CO12),

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J. Acupunct. Tuina. Sci. 2011, 9 (1): 388-396

Spleen (CO13), and Kidney (CO10), and Baihui

(GV 20), Yintang (GV 29), Qubin (GB 7), Shuaigu
(GB 8), Sizhukong (TE 23), and Fengchi (GB 20) in
body, and first tui-pushing Yintang (GV 29) Baihui
(GB 20), Yintang (GV 29) Sizhukong (TE 23) and
Baihui (GB 20) Qubin (GB 7) Shuaigu (GB 8)
the front areas of two ears by one-thumb technique,
an-pressing and rou-kneading Yintang (GV 29),
Baihui (GB 20), Qubin (GB 7), Shuaigu (GB 8),
Sizhukong (TE 23) and Fengchi (GB 20) in
predominance, and finally na-grasping the five
meridians, an-pressing and na-grasping Fengchi
(GB 20). After the treatment for two courses, the total
effective rate was 94.7%. Tang HZ, et al[35] treated 78
cases of chronic insomnia by comprehensively using
the digital an-pressing, rou-kneading, tui-pushing and
mo-wiping techniques on the head and back, in
combination of the scratching technique on the head
[namely Shenting (GV 24) Fengfu (GV 16),
Meichong (BL 3) Tianzhu (BL 10), Toulinqi
(GB 15) Fengchi (GB 20)]. After 3-course
treatments, the total effective rate was 89.7%. Zhang
XP, et al[36] treated 73 cases by rou-kneading and
an-pressing Jingming (BL 1) under music background.
After 4-week treatments, the total effective rate was
82.2%.

2 Discussion
In modern medicine that insomnia is defined as a
sleeping syndrome, caused by disturbance at the
beginning of sleep and maintenance of sleep, leading
to sleeping quality too bad to meet the physiological
needs and influencing the activities in the daytime[37].
There are two systems in the human brain, one for
sleep and the other for waking up. Due to imbalance
of the two systems by physiological or psychological
factors, the power of the system promoting the sleep
is not sufficient, inducing insomnia[38]. Most
practitioners of Chinese medicine believe that the
pathological position of insomnia locates at the heart,
in relation with dysfunctions of yin, yang, qi and
blood in the liver, spleen, gallbladder, stomach and
kidney[39]. And its pathogenesis stays no other than
dysfunction of Zang-fu organs, disharmony among
yin, yang, qi and blood, which inducing failure of
nourishment in the mind or disturbance of the mind.
Tuina treatment for insomnia is effective in the

therapeutic results, no adverse reaction and is easy to

be accepted by the patients. In the exploration of its
therapeutic principle, mainly the following aspects
can be summarized.
Tuina on the face and head: The head is a gathering
site of all yang and a house of smartness. Tuina
applied to the head and face can calm the mind and
stabilize the spirit, guide yang into yin and regulate
yin and yang. It has been indicated in modern studies
that tuina applied to the head can expand the basilar
artery, increase the blood flow of the brain and
improve the blood oxygen supply of the cerebral
tissues[40]. At the same time, the stimulation from the
gentle manual techniques can effectively regulate the
function of the cerebral cortex and restore the normal
physiological sleep[41]. For instance, the repeated
an-pressing and rou-kneading on Yintang (GV 29),
Shangjingming (Extra), Taiyin (Extra), Taiyang
(Ex-HN 5), and Baihui (GB 20) by the gentle
one-thumb technique can produce an inhibitory effect
on the cortex system of the brain, maintain the
cerebral cells in an orderly and synchronic status by
regulating the heart and spirit, beneficial to the
restoration of the cerebral cells and correction of the
dysfunctional nervous system, and to the maintenance
of the life centers of the cerebral cortex and subcortex
in a best cooperative status, so as to influence the
functional activities of the various organs and tissues
of the whole body. Therefore, the sleeping sense of
the patients would often be waken up during the
treatment[19].
Tuina on the back: The back is attributed to the
pathways of the Governor Vessel and Bladder
Meridian. The Governor Vessel goes inside the spine,
enters and communicates with the brain, supports and
nourishes the sea of marrow, governs yang and can
regulate qi, blood, yin and yang of the human body.
The Bladder Meridian links with the head and nape
upward and with the waist and lower limbs downward
from the back, where Back-Shu points of Zang-fu
organs are situated, and Back-Shu points are the
specific sites where qi of Zang-fu organs flow into the
back and lumbar region. The manual techniques
applied to the above areas of the back can dredge qi
activity, communicate with the heart and kidney,
nourish the heart blood, and calm the mind, for
balancing yin and yang and hosting the spirit and
stabilizing the mind[42]. It is believed in modern

394 Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2011

J. Acupunct. Tuina. Sci. 2011, 9 (6): 388-396

medicine that the skin bilateral to the spine is

connected with the internal organs via the
corresponding nerve segments. The stimulation
produced from tuina on the back and pinching the
spine can regulate the functions of relevant Zang-fu
organs by the sensory never fibers under the
attendance of the vegetative nerves and humor[43],
moreover, influencing the functional status of the
reticular structure of the brain stem by the reflex arc
and regulating the excitement of the cerebrum, so as
to treat insomnia[44].
Tuina on the abdomen: Several meridians go
through the abdominal region, including Yangming
Meridian with sufficient qi and blood. The spleen and
stomach are situated in the middle jiao. The spleen
dominates the ascending ability and the stomach
governs the descending ability. The spleen and
stomach are the axis for upflow and downflow of qi
activities. Tuina on the abdominal region can soothe
qi activities, strengthen the spleen and stomach, assist
the transportation and transformation, communicate
with the heart and kidney, and calm the mind. It has
been proved in modern medicine that the manual
techniques directly applied to the abdominal region
can strengthen the peristalsis of the stomach and
intestines, promote digestion absorption and excretion
of foodstuffs, and relieve the symptoms of tired limbs,
low spirit, poor appetite, insomnia and dizziness
caused by heart-spleen deficiency and disharmony
between the spleen and stomach[45].
Tuina on the foot: Two feet are linked with Zang-fu
organs by the meridian system, forming an inalienable
organic entity. Tuina on foot reflex areas can produce
the effects to dredge the meridian, promote blood
circulation and relieve fatigue. It has been proved in
modern studies that tuina on the foot reflex areas can
indirectly function on the upper and lower raphe
nuclei and lower locus ceruleus in the medulla
reticular formation of the central nervous system,
enhance the synthesis, storage and release of
5-hydroxytryptamine, and noradrenaline, and
remarkably increase slow- and fast-wave sleep of the
brain waves, thus improving the sleep status[46].
3 Problems and Prospect
The therapeutic effects of tuina for insomnia are
affirmative, but some common issues in the current
clinical study still exist[47]. The first issue is about the

standardization of manipulations, namely lack of the

unified standard about the time and course in
treatment of insomnia by tuina, and lack of
standardized study on time-ffect and dose-effect in
tuina for insomnia. The second issue is the sample
size. The samples are somewhat fewer in most studies,
it causing lack of representativeness in the research
results. The third issue is the scientificity of the
clinical trial. Due to lack of multi-center, large sample
and randomized control clinical trials, it impacts the
credibility of the research results. The fourth issue is
about standardization for therapeutic effect
assessment. Currently, due to lack of unified standard
for the therapeutic effects in the study, the clinical
results are far more different and can not
comprehensively reflect the results of the therapeutic
effects. Additionally, because many tuina experts have
their own specific viewpoints and have obtained the
satisfactory effects on treating insomnia, so how to
summarize their experiences and explain their
scientificity and popularize them in clinical service
will be a systematic project. The above issues are the
targets for our further study.

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Translator: Huang Guoqi ()
Received Date: August 20, 2011

396 Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2011