Gua Sha Treatment Plan and Pre- and Post-operative Precautions for Qi Stagnation and Blood Stasis and Spleen and Kidney Yang Deficiency

Kneading the calves: The practitioner uses the pads of their thumb and index and middle fingers to repeatedly knead the center of the patient's calf muscle 50-100 times. Kneading the feet: The practitioner uses the pads of their thumb and index and middle fingers to knead the entire sole of the patient's foot, repeating 1-2 times. When kneading the sole, apply slightly more force, move slowly, and perform the kneading in sequence until a local soreness and distension sensation is felt. Tapping the lower limbs: The practitioner uses a loose fist to continuously tap and pat the back of the patient's lower limbs, applying even and forceful pressure, without varying the intensity, repeating 2-3 times from top to bottom.

[Treatment Techniques] **Separating and Pushing the Buttocks:** The practitioner uses both hands to separate and push the patient's buttocks from top to bottom or side to side for 1-2 minutes. **Kneading the Buttocks:** The practitioner places both hands on the patient's buttocks and simultaneously kneads both sides of the buttocks, kneads the lumbosacral region with overlapping palms, uses the thumbs to press the Ciliao acupoint, and presses the Huantiao and Chengfu acupoints with the elbows, aiming for a feeling of soreness and distension. **Tapping the Lower Limbs:** The practitioner uses overlapping thumbs to slide and push along both sides of the patient's buttocks, and then taps the lumbosacral region, buttocks, and the back and outer sides of the thighs with loose fists. **Tractioning the Lower Limbs:** The patient lies supine with both knees bent. The practitioner holds the patient's knees tightly with both arms and uses both hands to press the patient's thighs towards the abdomen.

Flex the hips and knees as much as possible to stretch the muscles of the buttocks and lower back, then rotate the hip joint clockwise or counterclockwise. Push along both sides of the lower limbs: The practitioner uses both hands to push from the patient's buttocks towards the thighs to the knees, then uses both hands to push from the sides of the buttocks to the outer sides of the knees, repeating this for 1-3 minutes. Press acupoints on the lower limbs: The practitioner uses overlapping palms or forearms to knead the patient's buttocks and thighs, pressing or plucking the Huantiao, Chengfu, Yinmen, and Weizhong acupoints with the elbows, using the knuckles to massage the buttocks and the back of the thighs, and rhythmically tapping the lumbosacral region, buttocks, and lower limbs with a loose fist for 3-5 minutes.

Kneading and kneading the anterior thigh muscles: With the patient lying supine, the practitioner uses both hands to push the lower limbs down from the groin on both sides, using the thumbs and index fingers of both hands to knead and knead the anterior thigh muscles. The practitioner then taps the lower limbs with the little fingers of both hands, repeating this process for 3-5 minutes. Sliding and plucking the posterior thigh muscles: The practitioner places both palms on the inner and outer sides of the patient's thighs and kneads the inner and outer sides of the lower limbs. The practitioner then uses the thumbs of both hands to pluck the anterior thigh muscles from the inside out, and then uses the index fingers of both hands to slide and pluck the posterior thigh muscles from the inside out, repeating this process for 5-8 minutes.

The practitioner uses both palms to push and knead the patient's lower limbs, kneading the inner and outer sides of the limbs. Alternatively, the practitioner can slightly flex and externally rotate the patient's lower limbs. One hand stabilizes the outer side of the knee, while the other hand's forearm pushes and kneads the inner thigh, using the knuckles and fingers to tap the inner thigh with a loose fist. This process lasts 5-8 minutes. The practitioner then uses a sudden pull on the lower limbs: One hand holds the patient's ankle, while the other hand holds the patient's knee, flexing the knee and hip joints as much as possible. Then, the practitioner suddenly pulls the lower limb. The practitioner alternates between legs, pressing acupoints such as Qichong, Biguan, Xuehai, Fengshi, and Zusanli with the thumb for 3-5 minutes.

Straight Leg Raise: The patient lies supine with both feet dorsiflexed as much as possible. While dorsiflexing the feet, the patient raises the legs straight up, alternating between legs, repeating 20-40 times. Precautions for Massage for Weight Loss: 1. Each massage session should last a certain amount of time, such as no less than 15-20 minutes for the abdomen and no less than 45-60 minutes for the whole body. It must be done in courses of treatment, each course consisting of 10-12 sessions, with a 2-3 day rest period before starting the next course. 2. The massage therapist should be skilled, accurately select acupoints, and apply moderate pressure. Local lubricants may also be used.

1. It is best to use a lubricant such as a slimming cream. 2. During weight loss, eat less high-fat, high-calorie food and drink less alcohol, especially beer. Once you reach your ideal weight, pay attention to a balanced diet and appropriate exercise. 3. Abdominal massage should not be performed within one hour before or after meals, nor after drinking alcohol. 4. People with bleeding tendencies (such as stomach bleeding, intestinal bleeding, blood in stool, blood in urine, or women during menstruation) should not undergo slimming massage. 5. People with infectious diseases (such as hepatitis B, open pulmonary tuberculosis, etc.) should not undergo slimming massage.

For obese individuals with complications, the primary focus should be on treating these complications (such as hypertension, diabetes, and coronary heart disease). Weight loss massage can only be performed after the complications have subsided. 8. Massage therapists should trim their nails to prevent scratching the skin and wash their hands with warm water to avoid irritating the skin and causing muscle tension. 9. During the massage, the therapist should observe the client's reaction. If signs of tension, anxiety, paleness, cold extremities, nausea, or vomiting appear, the massage should be stopped immediately, and the client should rest or take other appropriate measures.

Massage for weight loss requires consistency; intermittent use will reduce its effectiveness. 11. Weight loss should be moderate; avoid drastic weight loss that could cause discomfort or other health problems. 12. Drink plenty of water after a massage; ideally, drink 2000 ml daily to aid in fat conversion and elimination.