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　Kneading Manipulation  


　Operating method
　1. The finger-kneading manipulation: Press a certain location with the end of the thumb and do the gentle soft and moderate circling activity. (Fig. 1)
　2. The palm-kneading manipulation: Press a certain location with the palm and do the gentle and moderate circling activity. (Fig. 2)
　3. The thenar-kneading manipulation: Press a certain location or acupoint with the greater or smaller thenar eminence and do gentle, moderate and circling activity. (Fig. 3)
　4. The palm-root-kneading manipulation: Press a certain location with the root of the palm and do the gentle and moderate circling activity. It may also fold the two palms and press a certain location with the roots of the palms and knead powerfully to the left and right directions. (Fig. 4)

  
Hold the handle of the needle with the thumb and the index finger and rapidly insert the needle into the point with a certain finger force.

　5. The forearm-kneading manipulation: Press a certain location with the ulnar side of the forearm and do the circling kneading or left-right kneading activity. (Fig. 5)
　6. The elbow-kneading manipulation: Press a certain location with the olecranon and do the powerful circling kneading or left-right kneading activity. (Fig. 6)

　Key Points of the Action
　1. The circling kneading with small amplitude of the distal end should be aroused by the proximal end of the body, e.g., that the forearm arouses the movement of the wrist and palm is called the palm-kneading manipulation.
　2. The place where the power is acted should be absorbed and fixed at the therapeutic location, and arouse the deeper tissues.
　3. The pressure should be even and the action should be harmonious and rhythmic. The general speed per minute is 120-160 times.
　4. The amplitude of the kneading should be moderate.

　Clinical Application
　The kneading manipulation is an important manipulation to relieve muscular spasm and eliminate fatigue. It can also alleviate pain at the injured location. If applied on the abdomen, it can regulate the gastric function.
　The finger-kneading manipulation is mainly used at the acupoints.
　The palm-kneading manipulation is usually used at the waist and abdomen.
　The thenar-kneading manipulation is used at the face and head.
　The palm-root-kneading manipulation, the forearm-kneading manipulation and the elbow-kneading manipulation are mainly used at the lumbar and sacral regions.

　Stratum and Characteristics of the Action
　When the kneading manipulation acts on the waist, back, four limbs, etc. the power should be made to reach the muscular stratum; when it acts on the abdomen, the power should reach the stomach and intestine; when it acts on the acupoint, the sensation, such as soreness, numbness, distension, and pain should occur; when it acts on the head and face and is used in cosmetology, the power only reaches the skin and subcutaneous region.
　The characteristics of the manipulation: Gentle, moderate, middle in stimulation, etc. It can be used in various portion of the whole body.

　Matters for Attention
　While applying this manipulation, attention should be paid to that the location where the power is acted should be absorbed and fixed at the therapeutic location, and the amplitude of the circling and spiraling should be moderate. If the amplitude is too large or too small, the effect of relaxation would be influenced.
　While operating, the doctor should relax his whole body, make qi sink to Dantian, breathe naturally and must not hold his breath.