When a client’s lymphatic system is already overburdened because of poor circulation, lymphedema, or lymph node removal, traditional massage is contraindicated.
Because traditional massage releases histamines from the mast cells, it causes a dilation of the capillary sphincters and therefore vasodilation, otherwise known as active hyperemia. In addition, more capillary pressure is created and therefore more capillary filtration occurs during massage, which is desirable in a healthy circulatory and lymphatic system, but not in a system that is already compromised.
How, then, do we safely and effectively work with clients with pre-existing edematic conditions or those at risk of lymphedema? The answer may well lie in an integrated and global holistic approach.
Edema Seen From Two Perspectives
In traditional Chinese medicine (TCM), the nature of edema is viewed as either being short and abrupt (yang edema) or slow and insidious (yin edema) in its cause and effect. As a result, a massage therapist’s plan of treatment should have both short- and long-term goals.1
The most common type of edema found in the massage therapy clinic, however, is yin edema, which takes weeks or months to progress. It starts at the top of the feet and ankles, slowly creeps up the legs, and settles in the waist. Yin edema is systemic and is caused by a combination of a toxic and excessive diet, lack of exercise or regular sustained movement, poor breathing habits, stress, pathologies of the organs, or trauma to a person’s physiological systems caused by surgery.
Whether your understanding of edema is from a Western or Eastern perspective, the principal organs of elimination heavily involved in the lymphatic system include the liver, kidneys, spleen, and intestines. But, in TCM, special emphasis is given to the spleen. This leads to the question: Why single out the spleen?
The Spleen’s Importance
The spleen is the largest lymphatic organ and has the same filtering function as lymph nodes. It also produces white blood cells called T-lymphocytes, which are an important part of the immune system. In TCM, the spleen is an Earth element and, in partnership with the stomach, is responsible for the transportation of nutrients. Whereas the stomach physically ripens and rots the food, the spleen is concerned with absorption and distribution of nutritious essences to all systems of the body. The metabolizing and breaking down of food into nutrients is essential; otherwise food stagnates in the stomach and intestines and turns into a damp slush. When there is a deficiency in this process, TCM refers to it as “dampness.”
Another function of the spleen is “sprinkling,” or moisturizing all the systems of the body as it sends fluids upward to the lungs. The spleen assists the stomach in sending the “turbid” or toxic liquids into the intestines and ultimately the bowels. While the spleen physically controls the nourishment of muscles and flesh, it also controls blood and lymph.
In TCM, clients with diabetes, fibromyalgia, and chronic fatigue have consistently weak spleens or weak spleen qi. Their digestion is sluggish and stagnated, and their overall circulation of blood, lymph, and body fluids is slow and impaired. These clients will complain of overall pain, diarrhea, irritable bowel syndrome, and fatigue.
Emotionally, from the TCM perspective, the spleen is responsible for negative worry and obsessive thinking. It also helps absorb information and logically categorizes it, as in reading a book or listening to a lecture. Muddled thinking and so-called “fibro fog” are believed to be the result of weak and stagnant spleen qi.
Movement is essential in helping these clients feel better. During a session, the therapist can gently “pump” the client’s spleen like an accordion for a minimum of 2 minutes (Image 1). The result is an amazing resurgence of qi.
Pumping or contracting the spleen is followed by acupressure on the stomach and spleen meridians, locally and distally, to move stagnant qi (Image 2). If there is sensitivity on the points, the therapist—with pressure not exceeding the weight of a coin—gently rotates counterclockwise (right to left as viewed by the therapist) until the sensitivity is gone. This disperses the stagnant qi. Then the therapist reverses the rotational flow and moves clockwise (left to right) to tonify or strengthen the qi in the organ. The rotation of fingers or thumbs on acupressure points is based on ancient TCM principles of acupuncture for propagating and enhancing qi flow.
As part of a comprehensive body-mind approach, the next step is to address distal points (found on the limbs) of the spleen, stomach, kidneys, and liver to create an abundant flow of qi that pushes the circulatory system. Through the use of certain key points, named “Golden Points” by some master acupuncturists in ancient China (gold, because of their high value in healing), a cluster of issues are successfully addressed.2
This could include balancing excessive emotions like anger, fear, worry, sadness, and hysteria. Over time, these emotions can turn toxic as they become deeply embedded in the psychological makeup of the client. One only has to read Hans Selye’s research on the effects of stress on the human body3 and mind to understand the importance of finding that balance.
In his theory of General Adaptation Syndrome, Selye showed that the body has a general response to demands made by stress that are either positive or negative. He proved that the syndrome induced hormonal autonomic responses, which, when left unchecked, can lead to ulcers, high blood pressure, arteriosclerosis, arthritis, kidney disease, and allergic reactions. Such a complex reaction, therefore, has to be treated with a set of acupressure points that address multiple physiological and organ systems.
Let the Emotions Draw a Map
When the emotional functions of the organs involved in lymphatic function are revealed, Selye’s General Adaptation Syndrome and the long-lasting effects of stress on the whole body make perfect sense. The liver is in charge of anger; the spleen and stomach (partners in the 24-hour circadian rhythm of qi) handle worry, concern, and obsessive thinking; and the kidneys oversee fear and fright. When these emotions are excessive, stress is generated on multiple organ and physiological systems. A comprehensive body-mind approach is then necessary.
As an experienced TCM therapist, my first question to the client, after finding out what has brought him or her to my clinic, is: What emotion rules your life or what emotion has lately been taking over your life? The answer can vary greatly, but in TCM, it can be principally narrowed down to four main categories: fear, anger, worry, and joy. It is only when there is an excess or deficiency of these four emotions that health issues emerge. The answer to my question can then lead me to a formula of acupressure points that address the client’s ailments successfully and economically.
Overall, the guiding goals in selecting all these acupressure points are increasing circulation and lymph flow; detoxifying the lymphatic system and chronic negative emotions; calming inflammation, both myofascial and organ-related; and boosting the immune system.
A typical distal acupressure protocol for yin edema starts at the feet and legs—all distal to the organs involved in edema—and progresses to the hands and arms. Also, by selecting mainly the Golden Points, most of the guiding goals will be addressed with these points. Thus, one can select Kidney 1 and Kidney 3 (Image 3) for energizing and centering; Spleen 6 (Image 4) and Stomach 36 (Image 5) for increasing circulation, immune system enhancement, detoxification, and metabolism; Large Intestine 4 for calming and strengthening the immune system, and anti-inflammation; and Urinary Bladder 23 for energizing all the organs (especially the kidneys and bladder), calming, and anti-inflammation. The kidneys are of paramount importance in this equation, because they provide energy for longevity and are ultimately connected to the well-being of all physiological systems.
When doing acupressure, take note of these guiding principles: If the points are sensitive to the touch, rotate with a finger pad or thumb pad counterclockwise for a minute or two, or until the sensitivity is diminished substantially. After going through all points from the feet to the arms, address the same points again, but this time rotate clockwise to increase energy to the channels and organs to which they are affiliated.
Lastly, with the client in a prone position, the therapist can pump the client’s feet up and down (Image 6). This exercise is aimed at contracting and stretching the soleus muscle. Compared to other lower extremity muscles, the soleus often acts as a second heart pump and provides most intramuscular pressure. According to Simon and Travell, “… Its pumping action increases the venous flow of blood from the feet and legs ... The soleus provides a major pumping action to return blood from the lower limb toward the heart.”4 This prevents venous blood from accumulating over time in the lower limbs as the result of prolonged inactivity.
Add Essential Oils to the Mix
When dealing with lymphatic issues, essential oils can be an ally. Research has established that acupressure and essential oils activate both the central nervous system and endocrine system by releasing hormones like endorphins, encephalins, dopamine, serotonin, etc.5 This means that both acupressure and essential oils deepen and lengthen the effect of any lymphatic drainage massage done on the skin and fascia by directly affecting physiological systems that aid in getting rid of edema and edematous conditions. Because we are directly tapping into the client’s physiological systems, both acupressure and essential oils prolong the effects of lymphatic drainage massage.
When choosing essential oils, therapists should make selections based on the guiding goals for choosing acupressure points. Depending on what health issues are most important to address, the therapist may choose a variety of oils. In massage therapy, it’s usually inflammation accompanied by pain that gets addressed first.
A good protocol to follow, then, would be to use lavender and chamomile for pain and inflammation; grapefruit for detoxifying the lymphatic flow; cypress for increasing general circulation; and peppermint for boosting the immune system. These oils can be applied in layers by using two drops each on the acupressure point after applying a general massage oil first, like jojoba oil, which can act as a carrier oil; do not place the pure oils directly on the skin. Alternatively, therapists can mix these oils in an 8-ounce bottle containing jojoba oil or any other carrier oil. The therapist can either select one each of the previously mentioned oils or several oils of each category. A typical formula for a lymphatic session would look like this: 14–16 drops each of lavender, grapefruit, cypress, and peppermint. If, however, the emphasis is on anti-inflammation and pain control, then the therapist could choose a combination of 14–16 drops each of lavender and chamomile, 8–10 drops of cypress and peppermint, and 5–6 drops of grapefruit.
The application with the essential oils alone can be one of simply rubbing them on the site of pain and/or the acupressure points by rotating the finger of application counterclockwise with very light pressure for about a minute (Image 7). If premixed with a carrier oil, then the therapist again applies the mixture lightly with long stripping strokes, starting proximally to the major lymph nodes and then working distally.
Because of the complex and chronic issues inherent in clients with lymphatic disorders, a multilevel approach consisting of essential oils, acupressure, and lymphatic drainage massage is necessary for successfully treating the client holistically. Try applying these principles to help edema-ridden clients regain their health.
Resources
Flaws, B. Sticking to the Point—A Step-by-Step Approach to TCM Acupuncture Therapy. 2nd ed. Boulder: Blue Poppy Press, 2007.
Hui-chan, Y., and H. Fu-ru. Golden Needle Wang Le-Ting. Boulder: Blue Poppy Press, 1997.
Jwing-Ming, Y. Chinese QiGong Massage. Jamaica Plain, MA: YMAA Publications Center, 1992.
Kasseroller, R. Compendium for Dr. Vodder’s Manual Lymphatic Drainage. Heidelberg, Germany: Heidelberg and Haug Press, 1998.
Lawless, J. B. The Illustrated Encyclopedia of Essential Oils. New York: Noble Books, 1995.
Lee, M. Insights of a Senior Acupuncturist. Boulder: Blue Poppy Press, 1992.
Travell, J., and D. Simon. Myofascial Pain and Dysfunction: The Trigger Point Manual—The Lower Extremities. Baltimore: Williams and Wilkins, 1992.
Schnaubelt, K. Advanced Aromatherapy: The Science of Essential Oil Therapy. Rochester, VT: Healing Arts Press, 1998.
Selye, H. “Stress and Distress.” Science 122 (October 1955): 629–31.
Shutes, J., and C. Weaver. Aromatherapy for Bodyworkers. Upper Saddle River, NJ: Prentice Hall Health, 2008.
Notes
1. Miriam Lee, Insights of a Senior Acupuncturist (Boulder: Blue Poppy Press, 1992).
2. Yu Hui-chan and Han Fu-ru, Golden Needle Wang Le-Ting (Boulder: Blue Poppy Press, 1997).
3. Hans Selye, “Stress and Distress,” Science 122 (October 1955): 625–31.
4. Janet Travell and David Simon, Myofascial Pain and Dysfunction: The Trigger Point Manual—The Lower Extremities (Baltimore: Williams and Wilkins, 1992): 429–32.
5. Kurt Schnaubelt, Advanced Aromatherapy: The Science of Essential Oil Therapy (Rochester, VT: Healing Arts Press, 1998).
Wolfgang Luckmann is an acupuncture physician and massage therapist who teaches workshops all across the country—most are based in traditional Chinese medicine and Ayurvedic philosophy. In 2015, he was inducted into the Massage Therapy Hall of Fame. For more information, visit www.wolfgangluckmann.com.