Working in accordance with the complex theory of TCM, Tuina is a complete healing system that harmonizes yin and yang and regulates the vital energy (Qi) by using rhythmic compression on to the distributions of channels (X, 2002). It is believed to closely resemble western massage, as many of the techniques are similar (Table 4). In spite of the similarities, there are more than 110 Tuina manipulations ranged from light stroking to deep tissue work (X, 2002), so the intent of Tuina is much more specifically therapeutic than massage. It is for both physiological healing of chronic pain that caused by musculoskeletal conditions and injuries on the back, neck and shoulders, as well as for psychological disorders such as tension and stress (X, 2002).
From the technical point of view, Tuina is a combination of massage, chiropractics, osteopathy and physical therapy however much more broad and encompassing than each of the modalities. Tuina treats diseases and is beyond the massage that simply relaxes muscle tension and increases local circulation. In addition, when comparing to the chriopractics that reduces misalignments in bony structures, Tuina is much more thorough to treat the muscles surrounding the diseased area prior and post the re-alignments, and minimize the rebound effect following the treatments (Cooper, 2010).

Similar to the mechanism of massage that is based on the mechanical irritation of proprio-/ inter- and extero-recptior and then reflected on tissues and organ, Tuina the hands-on therapy has a straight mechanical action on tissues that increases the blood and lymphatic flow, eliminates the disintegrated metabolic waste, improves swelling absorption and trophic tissue (Ilić et al., 2012). When gentle and light Tuina techniques are applied on the body, it stimulates the parasympathetic and restricts the sympathetic then to relax the muscles by applying gentle touch onto the skin. Oppositely, strong and firm techniques will inhibit the parasympathetic and promote the sympathetic and followed by activation of the central nerve system, and inhibition of the peripheral nerve system (Ilić et al., 2012). So after a usual timeframe of ten to 15 minutes Tuina, muscles at the local area will be sedated and relaxed.

Tuina activates both peripheral and central analgesia. Peripheral analgesia occurs through the trigger point and better regulation, while central analgesia happens by decreasing the brain stimulus (Cooper, 2010). It has been proven to be effective to chronic pain that caused by trauma and injury, such as whiplash syndrome. This is because different techniques of Tuina are designed for different purposes of treatment, including relaxing the tendons on neck, removing fatigue of muscles, inducing resuscitation, subduing swelling and relieving spasm, then to improve the moving ability of muscles and ligaments (Hinoveanu, 2010). Researches have also indicated Tuina promoting circulation of blood, increasing the blood flow viscosity and velocity in vertebral-basilar artery, then to reduce whiplash associated symptoms of dizziness, headache and neck stiffness (Ding et al., 2012). Not the least, Tuina is believed to alleviate soft tissue spasm, release compression of the cervical vessels and nerve roots (Zhou ZB, 2006), as well as reposition the joint displacement, ease the pressure on ganglion that caused by the swelling after injury (Li HD, 2006; Ma HS, 2006). “