It seems unbelievable when I look at it, but the first blog post I wrote about tui na and EDS went live in September of 2017. At the time, I was already a certified practitioner. I had started treating patients in a shared office space and was in the process of completing my second graduate program so that I could get licensed to practice acupuncture and herbal medicine. I was also just becoming very aware of EDS after a couple years of being somewhat conscious of the unique presentations of the numerous hypermobile patients I treated in student clinic.
I’ll link it here below. It’s a good blog post and still gets clicks even today. But I’ve certainly learned quite a bit since then. I have also since then completed that second graduate program, I sat for board exams and, as of 2018, I have been a licensed acupuncturist and herbalist. I also wrote a book (Chinese Medicine and the Management of Hypermobile Ehlers Danlos Syndrome, published by Singing Dragon in 2023). So it has definitely been a while, and yes, I do have updated thoughts to share about the modality and about the original blog post.
“Self-care, and not just for your body, is crucial.”
—Ehlers-Danlos Syndrome, Tui Na, and You: How Traditional Chinese Bodywork Can Make a Difference (Two Hearts Wellness, 2017)
First and foremost: I was pretty innocent and earnest when I first started treating patients with mystery conditions and chronic pain. Looking over that original gangster blog post (henceforth referred to as the OGBP) makes me smile now. And I do want to address certain parts of the OGBP here that, based on my now much more substantive experience level, I think are no longer accurate. But for me, what really stands out about that blog post is that I was such a learner then.
(Although, to be fair… I’m still a learner, and even if you have EDS and have been diagnosed since forever, you probably are, too. This is a condition that asks us to keep up with current research and to know ourselves. Don’t you think so?
Anyway…)
Before getting to the meta-commentary, I want to share a bit about tui na, the modality, and why it remains a staple of my practice. One thing has not changed a bit, and that is my belief in the value of tui na. It can be a life-changer for people with chronic pain and mystery conditions, from EDS to autoimmune disease to MCAS to your-labs-are-fine-you-just-need-to-lose-weight gaslighting victims, and more.
If you’ve never heard of it, or you’ve never heard the word spoken out loud, it is pronounced “twee nah,” which means “push” and “grasp,” respectively. It is somewhat like massage and it’s also akin to acupressure and channel work (as opposed to acupuncture directed to specific points). Tui na is one of the pillars of Chinese medicine (the others being: acupuncture, herbal medicine, nutrition, and the breath/movement practice known as qigong) and it is a medical specialty. If you are a practitioner in China, you can specialize and treat the same patients as a rheumatologist or an orthopedic doctor would. Tui na is less common here in the United States, and not everyone is as fortunate as I was. My school, at least, had a dedicated training program in tui na and my teacher in the program was a renowned instructor from Beijing.
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Dear reader, please know that it is important to work with a dedicated practitioner, not a dilettante, if you decided to try this venerable healing art. Keep in mind…not every acupuncturist is a tui na therapist and not every tui na therapist is an acupuncturist. Credentials do count. It is a form of medicine that requires both technical skill and knowledge of how to apply the specific techniques according the tenets of Chinese medicine. When you look for a practitioner (I’ll give links in the footnote here), look for one that is a certified practitioner.1
That said, let’s get to the fun stuff. My earnest blog post of 2017 has a lot of information that still holds true today and it’s got a couple things I’d like to correct, so without further ado… three direct quotes of what I wrote in the OGBP ( “Then“) as compared to what I know at present (“Now“) followed by “The Point” (which intends to sum things up nicely).
EDS is not rare & it deserves attention in academic curricula
Then: “The first time I ever worked with a known case of Ehlers-Danlos syndrome (EDS) person was in my office. They had come to me as a referral. Nothing was helping this person and their MD wondered if traditional Chinese bodywork therapy might provide some relief.”
Now: This patient wasn’t diagnosed, actually. However, it was my first known case in the sense that I knew what EDS was by then and was confident that this was what they had. Before that, in student clinic, I had a history of attracting patients I now realize must have had EDS. I didn’t realize it when I wrote the OGBP, but looking back? Yes. I will never forget my very first patient of my first rotation with my own room.2 That poor soul had so much going on and, looking back, I am certain that this person had EDS. I didn’t know it at the time, but in hindsight? I’m sure. And that patient was one of many.
Point being: We all know this, don’t we, but: EDS, especially the hypermobile version, is not as rare as it may seem. Yes, I attracted these patients to a remarkable degree during my student clinic years but I think more practitioners see zebras than they might realize. There needs to be much better education in acupuncture schools about EDS, and I think that any type of healthcare training, be it biomedical or Chinese, would benefit from a more meaningful focus on connective tissue disorder.
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It was inevitable…
Then: Oh, bless my soul but I was innocent back then… I really was. In the OGBP, I wrote about taking care not to injure patients and cited an article written by a person with hEDS, “The Masseuse Who Pulled My Arm Out.” A bit later in the OGBP, I wrote: “None of my clients have had their arms yanked out by a massage therapist.”
Now: Ah, I spoke too soon with this one! I have had patients get seriously injured during a massage. I have also had patients come to me after being injured by a physical therapist. And, I am sad to say, I have also had patients who were damaged by an acupuncturist. I’ve seen a lot since my first patient in my solo room during clinical internship, what can I tell you?
Point being: Credentials are important but so are listening skills. Anyone who gives you any kind of treatment, whether it be for mind, body, or soul needs to listen to you. They need to listen with their ears and hear what you say. They need to listen with their hands and not touch or move you with undue vigor. They need to listen with their heart, too, and meet you where you are. People with fragile connective tissue have often been through a lot when it comes to healthcare treatments. You deserve respect and you need it, for your safety. Do not think you are asking too much when you demand to be heard. You’re not asking for too much, by any means.
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Being a mastie is a whole entire life lesson…
Then: Here’s another one from the OGBP, and it’s a howler: “Did you know that Chinese medicine, and particularly the manual therapy known as tui na, plus moxa, might help?”
YIKES.
Now: Moxa (or moxibustion) is wonderful but it might not be a good idea for folks with MCAS. It’s burning mugwort (we would call it ai ye in Chinese medicine) and we would normally either put a small ball of it on an acupuncture needle to warm it or we can put it on a piece of ginger or other barrier and use it to warm your skin. This is a common treatment on specific foot points to help turn a breech baby and it’s also used for pain relief and/or to resolve menstrual difficulties. Not everyone offers moxibustion treatment in their office but practitioners who love it really love it, and some people really center it in their practice.
Myself, I was always a little sensitive to the smell of burning ai ye, but nothing too serious. However, my lifelong sensitivity to all-the-things eventually developed full-blown MCAS a few years back. You know how this ends up for me, zebra fam. You know. The long story short? Back when I was in a shared space, one practitioner occasionally used moxibustion on her patients. At one point before we eventually parted ways and I got my own office, I was in an ongoing (we’re talking months of this) stage where I could only eat five things and my mast cells were unmanageably volatile. She hadn’t burned moxa in a long while, but one day during that dark period, she did. And… can you guess what happened?
Yes. I experienced a dramatic anaphylactic reaction to the smell of the burning herbs. Upper lip swelling, roof of my mouth peeling off in one piece, pounding heart, throat closing, and more…yes, a whole entire 5-alarm MCAS super-flare. Now, I look back at my second graduate program and honestly wonder how it was that nobody ever had a reaction to the moxa during our techniques coursework. In clinic, we were encouraged to be sparing with our moxa treatment because some patients might react badly, but how this never happened during practicum classes kind of baffles me.
I don’t recall anyone having MCAS in my program but it’s not necessarily that rare either, so…
Point being: If you have MCAS (or even if you don’t), it is a good idea to look at the practitioner’s website and see if they offer moxibustion treatment. If you’re concerned, call and ask. Most of us are pretty good about having a no-perfume policy in the office (I sure have one) and many of us still mask (I do). But you never know. And if you have MCAS, my advice is to avoid it. You might not have a problem…but you know how MCAS is: when the Mast Cell Gods are angered, they are ANGERED. So do not tempt them with moxibustion (or if you must, then at least do so with caution).3
Those are the three big things from my innocent and earnest post. And while I’ve got you here reading about tui na, I’d like to add just three more points to ponder.
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It’s complicated
Tui na may sound simple (pushing and grasping) but it can be pretty complex, actually. Some things are subtle and might appear simple (they’re not). Thumb meditation technique, or yi zhi chan tui fa, which is when the practitioner uses one finger only, or a thumb, on one spot to effect change. It may appear simple but it definitely is not. This takes practice to learn to do properly, especially with EDS bodies and it can be surprisingly effective and it’s great for people who might not otherwise enjoy much tactile contact.
We also are the foundations of more than a few current modalities. For instance, I read a book on lymphatic drainage by a well-known practitioner and teacher, and they wrote about going to China and observing practitioners, saying that the tui na therapists were using techniques similar to ones used by lymphatic drainage therapists. (My thought? No, it’s the lymphatic drainage therapists who utilize techniques similar to those that have been used for THOUSANDS OF YEARS in China, thank-you-very-much).
We also can start from different perspectives and regions. I actually got really good at treating people’s feet because I had MCAS patients who were reactive to everything but foot treatment. (Our version of tui na for feet is akin to reflexology’s approach but our correspondences aren’t 100% the same).4 It may be that one joint is your subluxation monster joint, and we might not want to work directly on it. Instead, it might be better for you if your practitioner works on points that correspond but which are not directly on the weakened area. It all depends. But if you have specific areas that need attention and/or you have regions you want left alone, you still have a lot of options at your appointment.
It’s more than just pain relief
This isn’t just a pain treatment, either. Tui na is great for any number of conditions that we all know so well in the community. For instance, tui na on the abdomen can be excellent for people with gastroparesis. This can be either straightforward tui na or it can entail a Daoist philosophy and approach, in which case it would be more of a chi nei tsang treatment.5 Tui na is great for just about anything that acupuncture can treat, in sum. So if you’re not keen on acupuncture (and not all of my patients are), you still have options within Chinese medicine.
Feel the love
I love tui na, and so do my patients. Looking back on that first blog post is a reminder of how sincerely I wanted to help patients and how earnestly I applied myself to learning more about this condition (not realizing, at the time, that I was hypermobile myself, or that my life-long sensitivities were just waiting for their moment to burst forth into MCAS). It’s a reminder that there is always something new to learn, too.
What do you think? And are you interested in trying it? If so, remember: find a practitioner who is either certified and very, very dedicated or a licensed practitioner of Chinese medicine (and very, very dedicated). Make sure that the communication is good, and that they listen and either know EDS or are willing to learn. A light hand is better for you.
And remember: this is a way of delivering medicine that has been around for thousands of years for a reason. Tui na works, and honestly? It’s like magic. I love tui na, and I hope that when you experience it, you will say the same.
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Dr. Paula Bruno, Ph.D., L.Ac., is a licensed acupuncturist and herbalist, an AOBTA-CP traditional Chinese bodywork therapist, an author, and a health coach. She maintains an active and growing practice at Two Hearts Wellness, her Austin, TX office. Dr. Bruno is also available for distance appointments for wellness consultation or coaching.
In her first career, she was a Spanish professor.
Dr. Bruno’s specialties as a Chinese medicine practitioner include: • Musculoskeletal health (acute or chronic pain relief; Ehlers Danlos syndrome & hypermobility support) • Digestive support, gut health, and weight loss • Aesthetic treatment, including scar revision • Men’s health • General preventative care and wellness support for all persons.
She is the author of Chinese Medicine and the Management of Hypermobile Ehlers Danlos Syndrome: A Practitioner’s Guide.
When you are ready to discover what traditional medicine plus a vibrant and engaged approach to holistic health can do for you, either contact Dr. Bruno or book an appointment online.
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Two Hearts Wellness/Holistic Health & hEDS does not accept paid advertising on this website
Note: Material on this web site site is not intended to diagnose, prevent, treat, or cure any disease, illness, or ailment. A Chinese medicine practitioner in Texas identifies syndrome patterns but does not diagnose illness. Material on this web site does not purport to identify syndrome patterns.
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- Naturally, there is a blog post for this topic. If you are new to this website (holistichealthandheds.com) then allow me to clarify: Two Hearts Wellness is my original business and I created Holistic Health & hEDS because, by now, I have so much to say about EDS, MCAS, and dysautonomia that I decided to make specific website just for the community. In any event, the relevant blog post is at Two Hearts Wellness, here: “Find A Tui Na Practitioner: How To Find The Best Traditional Chinese Bodywork Therapist For What You Want To Accomplish.” ↩︎
- In my program, we undertook a lengthy supervised clinical internship that began with a term doing observation (you sit in a corner and watch a senior intern practice). Then you advance to working with a partner and a clinical supervisor in the treatment room and, eventually, you have your own treatment room with a clinical supervisor who only comes in to check on your work. My very first patient that first day in my own treatment room was… a lot. I am certain that they had EDS and also, more likely than not, MCAS. Like so many, this patient had been referred to student clinic by an MD who didn’t know what to do with them so that doctor suggested student clinic at the local acupuncture school. ↩︎
- “Acupuncture & EDS: How to Find a Practitioner of Chinese Medicine When You’re a Zebra” has good tips that you can apply towards finding a tui na practitioner when you’re complex and I do discuss the moxa issue and how to avoid surprises in it. ↩︎
- Another vintage post: “Happy Feet: What Tui Na Can Do For Your Aching Soles.” ↩︎
- From my blog post on the topic: “Chi nei tsang combines specific tui na (in other words, pushing and grasping) techniques combined with qigong, or qi movement, focused on the internal organs. Your practitioner may ask you to mindfully breathe a certain way or guide you in a meditation during this process. Though not a psychotherapy session, your chi nei tsang treatment can be a meaningful step in your emotional or spiritual healing path. There is an intangible component to a chi nei tsang treatment that ideally will manifest in a calmer mind/spirit (or shen, as we would call it in Chinese medicine) and greater ease within.” —Chinese-Style Abdominal Massage Can Change Your Life (Seriously, It’s Amazing). ↩︎
Holistic Health and hEDS 