Reidman college, the college of Traditional Chinese Medicine.

Final project.

Press your points. Acupressure as an additional tool for the practitioner and for the patient.

Student: Ekim Evgeny

Teacher: Malka Feldman

Preface.

When I was going to start my studies of Chinese medicine in Reidman college, I was familiar with therapeutic tools like acupuncture, acupressure and cupping. Cupping is used in almost every family in Russia to cure acute cough in children. Probably thats because of the geographical proximity of Russia and China. But also everybody knows what is acupressure and pointing massage or therapy, and of acupuncture is known all over the world. So at the beginning I have already known of the existence of magic points on the human body that can be treated by direct pressure or punctured by a needle to influence the hole body. I was very surprised to find that acupressure was not studied in the college. More than that, I found out that students were not aware of the existence of this therapeutic method. I really felt that acupressure was the most basic therapy in Chinese medicine, and it was very strange to me that at our lessons the teachers mentioned applying pressure only on few points: Pc6, St36 and GV26. Even on the lessons of TuiNa , where acupressure might be used very easily, my teachers did not pay an appropriate attention to this tool. Being a student at the first semester of the second year, I was really anxious to try using my knowledge to help my friends and parents when they needed my help. It was forbidden to use needles, so the only thing I could use was my fingers. Every time I met someone with nausea or hiccup I applied pressure to their Pc6 with 90% positive result. It was amazing! I also really helped my wife with her dysmenorrhea symptoms by applying pressure to Sp6, Sp8 and Sp10. I used acupressure to treat almost every symptom by picking up points from the list of acupoints that treat that symptom in the Manual of Acupuncture by Peter Deadman. And the results were very good. I showed people how to find the point that helped them, so they could help themselves next time they had their problem. The purpose of this work is to find and study specific information on this topic. I believe this technique may be very useful for me as a practitioner in various situations with 1

different kinds of clients and it can be very useful to use it by the client between the treatments to have a sustained continuous influence on his pattern of disharmony. I believe acupressure can noticeably improve the treatment results. So I will show in what clinical situations it is advisable to use this technique by the practitioner, and when it is useful to teach the patient to use it at home.

CONTENTS Preface. Contents. . What is Acupressure. . History of acupressure. Therapies that use pressure on body points. Advantages and limits of acupressure. 1 2 3 5 5 6

Ways to influence points. How to apply pressure to acupressure points. Hot spot therapy.

7 8 11

General directions for treatment Cautions and contradictions.

13 13

Treatment of common disorders. Nausea and vomiting.

2

14 14

Pain. Insomnia. Other disorders. My personal experience. Conclusion. Bibliography. Appendix

14 15 16 17 18 19 20

What is Acupressure? According to U.S. National Library of Medicine: Acupressure - a type of massage in which finger pressure on specific body sites is used to promote healing, relieve fatigue, etc. Although the anatomical locations are the same as the acupuncture points used in acupuncture therapy (hence acu-), no needle or other acupuncture technique is employed in acupressure. (www.definitions.net). Acupressure (sometimes written as "accupressure") is a technique related to acupuncture, where the energies of the body are regulated by manipulating points on the body.( www.eclecticenergies.com) The terms "acupuncture point", and " acupressure point" are used interchangeably to denote an identical and specific body point. Since the vast majority of the traditional literature on the subject of acupoints relates to the practice of acupuncture, most acupressure theory is simply transposed or extrapolated from this greater school of knowledge. Acuppressure may be seen as a direct offshoot of acupuncture wherein one or more known points on the surface of the skin, commonly called "pressure points," or "acupoints", receive pressure instead of having a needle inserted. The concept remains the same, it is to re-institute balanced energy flow through the body. That is why 3

acupressure is sometimes called "needleless acupuncture". Acupressure focuses on the same channels of energy, or meridians. The pressure can be applied using fingers, palms, elbows or specialized tools. Acupressure may be seen as a specific type of massage, dating back over 5000 years in ancient China. The benefits of massage and acupressure have been known for centuries. Massage as a form of therapy has been used by almost all cultures dating back to ancient Greeks and Romans where Hippocrates extolled its virtues as a form of medical treatment. There are several styles of massage in China today. The general term for massage is Anmo. The most common styles are Tuina and Zhi Ya. Tuina is the most common type of massage. Zhi Ya is based on acupressure. It is similar to Tui Na massage except it focuses more on pinching and pressing at acupressure points. According to A Practical Dictionary of Chinese Medicine, Zhi Ya and Shiatsu are actually the same, meaning - finger pressure, and the meaning of both of them is acupressure. Another traditional Chinese medicine therapy that utilizes pressure on acupoints is Pointing Therapy. It derived from Chinese martial arts, so-called Chinese Wushu. There have been tales told for centuries of martial art masters who with only a touch could disable or even kill an opponent. Martial artists soon discovered that the point striking techniques, when properly applied, were an efficient and effective means of personal protection. It was so effective, that by Shaolin law a teacher could only have one student in his lifetime and the information could only be taught verbally. This code was so strictly followed that many teachers went to their grave never revealing the secrets of Dim Mak(touch of death). Pointing Therapy is not acupressure, it is a therapeutic skill which has evolved from the Chinese martial art skill of tapping, grasping, pressing and holding acupuncture vital points. Safe, quick and effective, it is an extremely famous form of manual therapy in certain areas of China for the treatment of injury, stress, paralysis and pain. (www.pointingtherapy.com)

History of acupressure. Originating in India over 5000 years ago, acupressure spread to Asia and Egypt through traveling Buddhist monks, according to John Cross. In his book "Acupressure: Clinical Applications in Musculo-Skeletal Conditions," Cross notes that through a painstaking process of observation, played out over the centuries, ancient Chinese medicine practitioners mapped places on the body that became tender when their patients were ill with particular diseases. Stimulating these points relieved the symptoms of illness and helped create optimal health. The book Nei Ching record that during the reign of the Yellow Emperor (2690-2590 B.C.), stone tools were used to adfust the peoples Qi circulation, makin acupressure 4500 years oldLater, bronze needles replaced the stones, and gold and iron needles replaced the bronze needles (220 B.C.- 220 A.D.)(Utah College of Massage Therapy: 1999). One legend has it that acupuncture and acupressure evolved as early Chinese healers studied the puncture wounds of Chinese warriors, noting that certain points on the body created interesting results when stimulated. The oldest known text specifically on acupuncture points, the Systematic Classic of Acupuncture, dates back to 282 A.D. Acupressure is the non-invasive form of acupuncture, as Chinese physicians determined that stimulating points on the body with massage and pressure could be effective for treating certain problems.

Therapies that use pressure on body points. Acupressure is practiced as a treatment by Chinese medicine practitioners and acupuncturists, as well as by massage therapists. Most massage schools include acupressure techniques as part of their bodywork programs. These are some of the massage methods that use physical pressure to body points: Anma massage, Barefoot deep tissue massage, Lomi Lomi, Stone massage, Thai massage, Traditional Chinese massage (Tui Na and Zhi Ya), Shiatsu, Trigger Point Therapy, Deep Tissue massage, 5

etc. A lot of different modalities of holistic therapies also use acupressure in different forms in their practice. Here is a list of some of them: Yogic Acupressure, Tapas Acupressure Technique, Thought Field Therapy, Jin Shin Do, Auricular Acupressure, Shonishin pediatric acupuncture, Chopsticks Acupuncture, Emotional Freedom Technique, Su Jok therapy, Reflexology, etc.

Advantages and limits of acupressure. As we speak about the use of acupressure at home by the patient, we can see some obvious advantages:

The technique is easy to learn. No special equipment is required, the only items a person needs are their own fingers. For some points the fingers may be too thick, the simple pencil eraser thats on the other side of a pencil may be used. Different kinds of acupressure tools are available in the stores (see chap.2).

It can be performed anywhere, at any time. A person doesn't need to practice in a particular setting or a particular time of the day to experience its effects.

It is very safe, as long as a person follows the instructions provided by a licensed health care professional. No drugs are involved with acupressure; hence, there is no opportunity for drug-related side-effects to occur.

It offers a great deal of benefits to the patient. It can be very helpful for patients suffering from muscle pain, headache, dismeanhorrea, insomnia, nausea, etc.

However, acupressure is not without its limits. Applying acupressure too abruptly, or using too much force during treatment, can lead to bruising and discomfort. Special care should also be taken by pregnant women or those with recently-formed scars, burns, infections or skin lesions. That is why the patient must precisely follow the practitioners advise. As we look at acupressure as a technique for the practitioner we cant talk about disadvantages, because this tool can only help when used in appropriate situations. In practice, the main difference between acupuncture and acupressure/massage

techniques is that acupuncture tends to have a delayed effect but last longer than acupressure/massage. People often feel better right after acupressure/massage but the effect tends to be temporary and stubborn problems often return. (www.laverneacupuncture.com/acupressure-and-massage) The advantages for the practitioner are: Acupressure is well accepted by people with tendency to faint when receiving acupuncture. It can be used to activate Jing Well points near the patients nails instead of using needles, when used on new patients or patients sensitive to pain.(see chap.2) In many cases, as the patient practice it between the treatments, acupressure can produce long-lasting stimuli in the treatments of chronic diseases. It can be easily combined with any other therapeutic tool like acupuncture, moxibustion, cupping or Tuina to enhance the treatment.

Ways to influence points. As I said in the previous chapter the body points may be activated in different ways. The practitioner may use almost any part of his upper and low limbs to press the patients points. He may also make use of various tools to do that. It depends on the patients constitution, location of the point and practitioners pressing skill. The doctor of pointing therapy must have a strong constitution and a good pointing, pressing, pinching, clapping and knocking the points or stimulant lines. It therefore, is necessary for the beginner to build up both physical strength and technical skill (Jia Li Hui: 1990). In this book the authors introduce a study program for the beginners to muster those skills. The patient may also use any tool for home treatment, it depends on the practitioner and his instructions. 7 How to apply pressure to acupressure points.

1. There are two ways to apply pressure with the thumb. - The thumb is fully extended and the other four fingers are separate (1). - The second joint of the thumb is on the radial aspect of the index finger (2).

The angel of application is 45-90 degrees from the body surface. There is a pressing-stirring method: the practitioner stirs the thumb upward, downward, to the right and to the left while pressing. If the end of thumb rotates during pressing, it is called pressing-twisting method. No sliding is allowed in above methods to avoid injure to patients skin. 2. Another way to apply pressure is Yi Zhi Chan, One finger meditation steady direct pressure usually with the thumb tip, or with the middle finger tip. The hand is cupped in a loose fist supporting the thumb resting on the index finger.

Direct pressure or rhythmic vibration is applied by rocking the wrist and hand back and forth. (Pic2,3)

Pic2

Pic3 8

3. The middle finger is the longest of all fingers and is well suited for applying acupressure (Pic3). The thumb is strong, too, but often lacks sensitivity. 4. The practitioner may use knuckles, elbows, toes, feet and knees to apply pressure on some points. A general guideline to follow is that the pressure should be firm enough so that it "hurts good" - in other words, something between pleasant, firm pressure and outright pain.The more developed the muscles are, the more pressure one should apply. If the patient feels extreme (or increasing) sensitivity or pain, the pressure should be gradually decreased until a balance between pain and pleasure is found. When the point is located and ones fingers are comfortably positioned right on the spot one may gradually lean his weight toward the point to apply the pressure. Using the weight of the upper body (and not just hands) enables to apply firm pressure without strain. Gradual, steady, penetrating pressure for approximately one - three minutes is ideal. Then the pressure should be gradually released, finishing with a soothing touch.

5. Pinching. The practitioner claws the patients nail with thumbs or index finger nail. During pinching, the practitioner should hold the patients wrist or ankle joint with one hand to avoid contraction of patients hand. With other hand he should pinch the patients finger or toe and claw the point with a nail.(Pic4) The strength and frequency of clawing depend upon the syndrome being Shi or Xu. Pinching is used for treating paralytic and brain diseases, ataxia, headache and fever due to exogenous factors. The action of pinching must be even and 1-2 times per second, or 2-3 times per second. The application of pinching should be continuous and the strength should increase gradually. It is important to avoid injure to patients skin. (Jia Li Hui: 1990)

Pic4. This technique is only used to influence Jing-well points of 12 meridians and therefore may be useful for treating fainting, paralytic diseases, brain diseases, ataxia, headache, fever due to exogenous factors, etc. 6. Pinching the abdominal points. I have tried to use pinching technique to influence points that are situated on the abdomen. I have tried this, because I have found it inappropriate to try pressing the abdomen. I have pinched and squeezed the skin and subcutaneous tissue in the area of St19 St24 to reduce the pain in the stomach area. It is essential to find small painful nodules in the subcutaneous tissue and to induce pain for several seconds. Ive been using this technique on myself and on my family to treat abdominal pain from any etiology with very good results. 7. The pressure may be also applied with simple tools like avocado pit, a golf ball, tennis ball, or a pencil eraser. The Tennis ball acupressure called Hot spot therapy is described in the next chapter. 8. Adhesive tape for use on skin to press ball-bearing balls on points may be used. A similar method is used in Ear Acupressure and in Su Jok therapy. The metal balls 4 mm diameter and nylon rings on top of them (to supply a larger surface to the tape) are adhered to the skin. It is well suited for points with a small diameter like points situated on palms and feet. It may be useful to send the patient home with this adhered ball, to make him remember the location of the points the practitioner wants him to press, and as a reminder to do that. 9. There is plenty of different types and shapes of devises for self-treatment and for practitioners. Some of them are for orthopedic problems, others are used as a substitute 10

for the thumb to press points for other complaints. There are patents for such apparatuses as acupressure type rhinitis therapeutic device, acupressure glove device, apparatus for head acupressure using air pressure, and even intraoral acupressure apparatus! (see Appendix 2). The tool must be first tried by the practitioner to be advised for the home use.

Hot spot therapy. A good way acupressure may be used by the patient on their back muscles is so called Hot spot therapy. It is very useful in patients with complaints on middle and upper back pain , especially when painful back shu points are found, and these finding fits with the diagnosis. When a particular organ system is in a pathological state the paraspinal muscles of the affected segment are usually tight or knotted. The muscle tightness constricts the vessels and nerves passing through it and further impedes the flow of qi and blood. Releasing some of this tension has a beneficial effect on qi and blood movement through the segment, and on the function of the underlying organ system.(Will Maclean, Jane lyttleton: 2010) The technique involves a device made from two tennis balls placed in a sock with a knot tied between them. This enables the patient to apply pressure bilaterally with a ball sitting on both left and right Urinary Bladder channels with the knot over the spine. It can also be done in a firm chair or leaning against the wall. The technique is quite simple. In essence it is simply sustained pressure applied to specific loci, done by the patient at home for 10 minutes or so every day. The regular pressure on the appropriate spots gradually leads to a sustained softening of the superficial tissues, better qi and blood flow and improved organ function.( Will Maclean, Jane lyttleton: 2010).The technique can be applied along the length of the erector spinae muscles, from Bl13 to Bl25, the main area of interest lies between Bl15 and Bl20. The patient lies on the bed or the floor with the tennis balls placed on either side of the spine. Using his legs to move and make fine positional adjustments he seeks the sorest spots, those with the most stagnation, and once located relax into them and let their body weight provide the required pressure. The pressure should be strong and 11

may initially hurt, but should not be so strong that the patient tenses up against it. If the pressure from the body weight is too much, a softer surface may help. Once the points have been located the pressure should be maintained for a few minutes, or until the soreness clearly decreases, the tension releases and the points give. The technique can also be done in a firm chair or leaning against the wall. The time is important because what is being stimulated is a neurological reflex the pressure sends a signal to the brain, which after a certain period, usually no longer than 90-120 seconds, sends a signal back to the muscle to release, the 'give'. Pressure maintained after the release is unnecessary.(Will Maclean, Jane Lyttleton : 2010) Tennis balls are selected because they have the right balance of firmness and elasticity to provide a good degree of pressure without undue discomfort. The benefits accumulate gradually, with persistent practice providing significant and sustained result. This technique is most useful in excess patterns, especially those with a component of Liver qi constraint.

I have a rich experience of using this therapy on myself since I have been practicing it for nearly 3 years. I had a cronic upper and middle back pain for a year before I started using tennis balls. I found it to much painful to lie on the balls, so I used them leaning against the wall. I found it important to make some stretching exercises for back and neck muscles after pressing on the painful points to gain a balance in the whole muscle that I applied pressure to. Otherwise the stagnation from the prolonged pressure in one part of the muscle will disturb the work of the whole muscle and stiffness may be felt. Another important thing is to press one point only for one minute maximum or until the point becomes less painful. Otherwise the point becomes even more painful and is felt like a bruise the day after. It is also important to apply pressure only to one or two most painful points on either side of the spine, and not on every painful point. So the best routine Ive created for me is to lean against a wall and to find the most tender points on my middle back muscles with the balls and to press them till the pain is reduced substantially. Then I make a sort of massage for the hole back from the neck till the low back by pressing and kneading the bladder meridian point after point with the balls. It 12

takes several seconds for every couple of BL points, just 2-3 minutes in total. And at the end I make stretching exercises for 3 minutes more. This everyday session takes me 10-15 minutes and it has been solving my back problems very well. General directions for treatment. Like in acupuncture the points may be tonifyed or dispersed depending on the case. Tonifying is done by pressing the thumb or finger into an acupoint with a firm, steady pressure, holding it for up to two minutes. Dispersing is done by turning a finger over the point in counter-clockwise direction, like in pressing-twisting method mentioned above.

It is important to explain the patient not to treat himself for more than 20 minutes, for the purpose not to exhaust qi and course complications, such as nausea and headaches. At the beginning pressing one point for two to three minutes is enough. One should not hold any one point longer than ten minutes. Cautions and contradictions. Patients with acute inflammatory diseases, hemophilia, purpura hemorrhagica, purpura allergic are contradicted to acupressure. Acupressure should not be applied to open wounds, or where there is swelling and inflammation. Areas of scar tissue, blisters, boils, rashes, or varicose veins should be avoided. The treatment should not be given to drunk or over fatigue men. Finally, certain acupressure points should not be stimulated on people with high or low blood pressure and on pregnant women.

The slight skill should be given in the end of each treatment, especially for those with weak constitutions, over hungry, over feeding, first visit patient, women with menses, pregnant women etc. If dizziness, nausea, pale face or faintness occur, pressing gv26 or pinching the nail roots should be given.

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Treatment of common disorders. In this chapter I would like to discuss the treatments of the disorders that are likely to respond well to acupressure treatment. Acupressure books for the lay public provide unreliable information on treating almost every ailment by home acupressure. As I have not found enough acupressure books for practitioners, I have looked for some evidence that rely on research.This researches can give me confidence in the clinic. It also can help to convince the patient to use acupressure at home. Ideological work for the patient should be made carefully during application of pointing therapy in order to gain patients initiative and confidence. (Jia Li Hui: 1990) According to the US National Center for Biotechnology Information acupressure may be beneficial for pain, nausea and vomiting and sleep. (pubmed.gov)

1. Nausea and vomiting. -The treatment of the acupoint PC6 Neiguan may be applied to treat nausea and vomiting, even with the application of acupressure alone. (pubmed.gov) - A Cochrane Review on PONV(Post Operative Nausea and Vomiting) concluded by stating that, compared with sham treatment, acupoint stimulation significantly reduces the need for rescue antiemetics. (cochrane.org) -From a Cochrane Review on CINV(Chemotherapy Induced Nausea and Vomiting), it emerged that acupressure is effective for both mean and worst acute nausea severity, and, therefore, acupressure is able to offer a no-cost, convenient, self-administered intervention for chemotherapy patients to reduce acute nausea. (cochrane.org)

Because of the fact that Neiguan is such a potent point for nausea, it may be the single acupressure point to be used between acupuncture sessions or as an additional treatment for other treatment modalities.

2. Pain. Dismenorrhea, PMS and pain during labor. - SP6 acupressure could be regarded as a self-manageable approach to improve 14

women's general health (ncbi.nlm.nih.gov). - Acupressure at Sanyinjiao SP-6 can reduce pain during the active phase of labour, according to a randomised controlled trial carried out by Swedish researchers in a public hospital in India.( www.jcm.co.uk) - LI4 acupressure was effective at decreasing pain and duration of labor in the first stage of labor (ncbi.nlm.nih.gov). - Researchers from Iran suggest that acupressure at Sanyinjiao SP-6 could be a costeffective intervention for improving primary dysmenorrhoea (ncbi.nlm.nih.gov). - Acupressure at the SP6 and SP8 points can reduce pain severity of dysmenorrhea for up to 2 hours after application, and these points may be used to alleviate the severity of systemic symptoms accompanying dysmenorrhea( www.jcm.co.uk). Pointing therapy can effectively stop abdominal pain. If dysmenorrhea is functional without any organic alteration and the patient can insist on treatment before each menstruation, this disease can be cured. (Jia Li Hui: 1990) In his book the author suggest that pointing therapy may be given during any phase of menstrual cycle. The treatment should be given as follows: First, select and press a painful point in the abdominal region. Increase the intensity of manipulation gradually till a burning sensation in the lower extremity and abdominal region appears. At the same time press the points Cv4(GuanYuan), St30(QiChong), Sp11(Jimen) and extra point Qipang( 3 cun laterally to the umbilicus). Then let the patient take a prone position and press Yaoyan(2.5 cun laterally to the low border of second lumbar vertebra).

In the book Acupressure by Utah College the authors suggest to treat PMS and painful periods with Cv6, Sp12, Sp13, Bl27 to Bl34, Bl54, St36, Sp6, Liv3 bi laterally, starting with a less painful side.

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3. Sleep. - Study supports the hypothesis that valerian acupressure(acupressure and valerian aromatherapy) on the Shenmen, Neiguan, and Yongquan acupoints could improve the sleeping time and quality of intensive care unit patients( www.jcm.co.uk). - Researchers from Taiwan have found that auricular acupressure contributes to an improvement in postmenopausal insomnia by regulating the autonomic nervous system ( www.jcm.co.uk). It is recommended (and widely applied in China) for patients suffering from insomnia to massage bilateral Yongquan KID1 before bedtime, or to steep the feet in a bowl of hot water to draw down the excess yang. (Deadman: 2007)

4.Other disorders. - Acupressure "Significantly Influences" the Cardiovascular System.(Acupuncture Today May, 2000, Vol. 01, Issue 05) Therapy Creates Changes in Heart Rate, Blood Flow and Arterial Pressure. In the pressure group, 24 classical acupoints (KI7; KI3, PC9; PC7; Liv8; Liv3; LU9; SP2; SP3; HT9; HT7; and LU7, bilaterally) were stimulated in order using firm pressure. Results of the treatment showed dramatic cardiovascular changes in the pressure group. Heart rate, for instance, decreased an average of seven beats per minute in the group receiving acupressure, compared just one beat per minute in the control group. Similar changes in arterial pressure and skin blood flow were seen in the pressure group. - Subjects using acupressure at Li11for 4 weeks had improvement in pruritus and lichenification associated with atopic dermatitis (ncbi.nlm.nih.gov). - Study finds acupressure more effective than physical therapy in low back pain. The effect was not only seen in the short term but lasted for six month (ncbi.nlm.nih.gov). In blockage of the ears during or following flying, Zhongzhu SJ-3 may be massaged or needled whilst the patient pinches their nose shut and attempts to blow through it (Deadman: 2007). 16

My personal experience. As I said in the preface, Ive been practicing acupressure for 4 years since I started to study TCM. Being a massage therapy practitioner for 3 years Ive always tried to add acupressure when appropriate. So Ive made some findings of my own, some of them I havent seen in any acupressure book. For example I have found out that pressing Tw5 is much more effective for headaches than any other distal point, namely Li4, Lu7, St44, Liv2, etc. Ive treated almost 30 patients with only pressing this single point for 15-30 seconds with only one person that did not feel any improvement in pain. One of the patients was a 25 years old woman with a hard migraine attack for 20 hours after taking 7 pills of the strongest drug she had. Its a miracle she said the day after I felt no pain for 10 minutes, but 10 minutes of heaven are worth of 10 seconds you pressed me that point. Another patient in our students clinic was suffering from headache from wind-cold attack. So he got standard treatment for this type of headache: li4, lu7 and gb20 bilaterally. After insertion of the needles he did not feel any improvement. After 10 minutes of no improvement I applied pressure to his Tw5 on his right hand for 5 seconds and he felt his headache was almost gone. So I inserted a needle in that point and his pain was totally gone and did not come back that day. In this case I was pretty sure that puncturing Tw5 would help, because the pressure worked nice. On the other hand I tried to help another friend of mine that had a strange terrible headache for two days and even went to the emergency room the night before. When I pressed his tw5 he felt a very intense pain like a gunshot in his head. So I was sure I could neither puncture nor press this point. These cases suggest that it may be very helpful to try pressure on the points we want to puncture first to get a feedback from the patient, especially when we want to reduce pain distally in any part of the body. This may help the practitioner to determine what points to choose.

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Conclusion. Traditional Chinese medicine is a broad range of medicine practices sharing common theoretical concepts which have been developed in ancient China, including various forms of herbal medicine, acupuncture ,moxibastion, massage (Tui Na and Zhi Ya), exercise (qigong), dietary therapy, cupping, guasha, Pointing therapy, acupressure and Die-da(bone setting). As a student Ive been taught almost every practice from this list, except Zhi Ya, acupressure, Pointing therapy and Die-da. The last two are not common in the west because of their complexity and specifications. Zhi ya massage and acupressure are actually the same. So the only thing that Ive felt missing a lot in my studies is acupressure. Because Ive felt that it is the only simple tool that can be easily added to every other practice and more than that, it could be given as a home self-treatment to the patient. Unfortunately there are no professional books on acupressure and Zhi Ya massage on the internet web stores. The only book Ive got is about Pointing therapy, which is very closely related to acupressure, but being a very profound therapeutic discipline which requires specific education by the Pointing skill masters in China, it cannot be studied by the means of this small book only. Yet this is the only book which provides information for Tcm practitioner, as apposed to all the other books and websites Ive found which address to the lay public. It hasnt been easy to combine these different kinds of information to compile this small brochure on acupressure for the practitioners. I am very glad that I have had this opportunity to study this practice by myself doing this project. I really feel that now I have a powerful tool in my arms which gives me more options for treatment and rises my chances to succeed on my way of bringing balance to the peoples lives.

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Bibliography: Utah College of Massage Therapy, 1999: Acupressure, Salt lake city. Jia Li Hui, Jia Zhao Xiang, 1990: Pointing Thrapy, Shandong: Science and Technology Press. Will Maclean, Jane lyttleton, 2010: Clinical handbook of internal medicine. Volume3, Hong Kong: Pangolin Press. Peter Deadman, 2007: A manual of acupuncture. England: Chinese medicine publications. Donna Finando, 2008: Acupoint and Trigger Point Therapy. Vermont: Healing Arts Press. Stephen Birch, 2011: Shonishin: Japanese Pediatric Acupuncture. China: Everbest Printing Co. Ltd. Keith Kenyon, 1974: Acupressure Cure for Common Diseases. India: Saurabh printers. www.ncbi.nlm.nih.gov www.jcm.co.uk www.definitions.net www.eclecticenergies.com www.acupressure.com www.cochrane.org

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Appendix.

Pic2

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