Is Tui Na a Promising Approach for Autoimmune Diseases? A Review of Clinical Studies and Mechanisms
Keywords:
Tui Na, Traditional Chinese Massage, Autoimmune Diseases, Rheumatoid Arthritis, Multiple Sclerosis, Amyotrophic Lateral Sclerosis, Ankylosing SpondylitisAbstract
Autoimmune diseases, characterized by immune system dysfunction targeting healthy tissues, affect millions worldwide. While conventional treatments have advanced, unmet needs persist. Tui Na, a traditional Chinese massage therapy, has gained attention as a potential complementary treatment. This review explores Tui Na’s role in managing autoimmune conditions. A comprehensive literature search was conducted to identify studies investigating the use of Tui Na for autoimmune diseases in several databases. The available evidence suggests that Tui Na may offer potential benefits for individuals with autoimmune diseases. Studies have reported improvements in pain, fatigue, and overall well-being. Combining Tui Na with conventional treatments has often yielded enhanced outcomes. However, the evidence base is limited by a paucity of high-quality rando-mized controlled trials. Tui Na’s potential as a complementary therapy for autoimmune diseases is promising. Its ease of application and reported benefits warrant further exploration. However, the underlying mechanisms remain unclear, and the evidence base is insufficient to establish definitive recommendations. Future research should focus on rigorous study designs, larger sample sizes, and mechanistic investigations. Integrating Tui Na into comprehensive care plans requires careful consideration of patient-specific needs and potential interactions with conventional treatments. In conclusion, Tui Na shows promise as a complementary therapy for autoimmune diseases, offering potential benefits in symptom management and quality of life. While preliminary findings are encouraging, robust research is needed to establish its efficacy and safety
References
National Institute of Arthritis and Muskuloskeletal and Skin Diseases. Autoimmune Diseases: NIH; [updated March 2023 [Internet]. [cite 2025 Oct 14]. Available from: https://www.niams.nih.gov/health-topics/autoimmune-diseases.
National Institute of Environmental Health Sciences. Autoimmune Diseases: National Institute of Health [Internet]. [cite 2025 Oct 14]. [Available from: https://www.niehs.nih.gov/health/topics/conditions/autoimmune.
Angum F, Khan T, Kaler J, Siddiqui L, Hussain A. The Prevalence of Autoimmune Disorders in Women: A Narrative Review. Cureus. 2020;12(5):e8094. PubMed PMID: 32542149
Autoimmune Registry. Autoimmune disease registry: Autoimmune Registry [Internet]. [cite 17 Nov 2024]. Available from: https://www.autoimmuneregistry.org/autoimmune-diseases
Autoimmune association. Autoimune Disease List [Internet]. [cite 17 Nov 2024]. [Available from: https://autoimmune.org/disease-information/
Conrad N, Misra S, Verbakel JY, Verbeke G, Molenberghs G, Taylor PN, et al. Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: a population-based cohort study of 22 million individuals in the UK. Lancet. 2023;401(10391):1878-90.
Miller FW. The increasing prevalence of autoimmunity and autoimmune diseases: an urgent call to action for improved understanding, diagnosis, treatment, and prevention. Curr Opin Immunol. 2023;80:102266.PubMed PMID: 36446151.
Ramos PS, Shedlock AM, Langefeld CD. Genetics of autoimmune diseases: insights from population genetics. J Hum Genet. 2015;60:657-64.
Invernizzi P, Pasini S, Selmi C, Gershwin ME, Podda M. Female predominance and X chromosome defects in autoimmune diseases. J Autoimmun. 2009;33:12-6.
Morton Cuthrell K, Tzenios N, Umber J. Burden of autoimmune disorders; a review. Asian Journal of Immunology. 2023;6:1-13.
Wang L, Wang FS, Gershwin ME. Human autoimmune diseases: a comprehensive update. J Intern Med. 2015; 278:369-95.
Huang T-Y, Hirota M, Sasaki D, Kalra RS, Chien H-C, Tamai M, et al. Phosphoenolpyruvate regulates the Th17 transcriptional program and inhibits autoimmunity. Cell Reports. 2023;42:112205. PubMed PMID: 36857180
Haghikia A, Hegelmaier T, Wolleschak D, Böttcher M, Desel C, Borie D, et al. Anti-CD19 CAR T cells for refractory myasthenia gravis. Lancet Neurol. 2023;22: 1104-5.
Morand EF, Fernandez-Ruiz R, Blazer A, Niewold TB. Advances in the management of systemic lupus erythematosus. BMJ. 2023;383:e073980. PubMed PMID: 37884289
Nastasio S, Mosca A, Alterio T, Sciveres M, Maggiore G. Juvenile autoimmune hepatitis: recent advances in diagnosis, management and long-term outcome. Diagnostics (Basel). 2023;13(17):2753. PMID: 37685291
Yang X, Zhao H, Wang J. Chinese massage (Tuina) for the treatment of essential hypertension: a systematic review and meta-analysis. Complement Ther Med. 2014;22:541-8.
Kong LJ, Fang M, Zhan HS, Yuan WA, Pu JH, Cheng YW, et al. Tuina-focused integrative chinese medical therapies for inpatients with low back pain: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2012;2012:578305. PubMed PMID: 23346207
Pritchard S. CHAPTER 1 - Foundations and development of Tui na. In: Pritchard S, editor. Tui Na. Edinburgh: Churchill Livingstone; 2010. p. 3-14.
Matos LC, Machado JP, Monteiro FJ, Greten HJ. Understanding traditional Chinese medicine therapeutics: an overview of the basics and clinical applications. Healthcare (Basel). 2021;9(3):257. PMID: 33804485
Greten HJ. Understading TCM, the fundamentals of Chinese medicine Part 1. 6 ed: Heidelberg School Editions; 2013.
Wang J, Yang C, Bai W-l, Bai Q. Effect of massage of leading Yang into Yin combined with breath guided method on anxiety symptoms in patients with rheumatoid arthritis. Clinical Research and Practice. 2019(4):110-11.
Hong B, Xiao-xiang Y. Treatment of rheumatoid arthritis by warmed needling plus Chinese massage. Journal of Acupuncture and Tuina Science. 2004;2:22-3.
Chen S. Effect of herbal bamboo cupping therapy combined with acupoint massage on pain symptoms of rheumatoid arthritis patients. Medical Innovation of China. 2019(23):116-9.
Cai F. Clinical study of Long’s bone setting massage combined with acupuncture and traditional Chinese medicine on rheumatoid arthritis (cold and dampness obstruction type). The Medical Forum. 2021(26):3803-5.
Qin T, Li L, Liu Y. Influence of external application of traditional chinese medicine powder combined with massage on knee joint function of rheumatoid arthritis patients with knee joint damage. Clinical Medicine Engineering. 2021:895-6.
Wang Z, Rong K, Cai P, Huang D, Ruiliang L, Kuang Y, et al. Curative effect observation of rheumatoid arthritis with syndrome of blockade of wind-cold dampness treated with Tiebaojin massage cream. Clinical Journal of Traditional Chinese Medicine. 2019:2156-9.
Wang J. Chinese moxibustion and massage therapy in rheumatoid arthritis parallel randomized controlled study. Journal of Practical Traditional Chinese Internal Medicine. 2015:151-3.
Nie Z, Han D, Xu K, Yao J, Ouyang G. Clinical observation of Chinese medicine herbal fumigation combined with massage for treatment of rheumatoid arthritis of knee joint. Medical Recapitulate. 2020:1452-6.
Li Y. Discussion on the value of oral chinese herbal medicine combined w ith fumigation and massage therapy in the treatment of rheumatoid arthritis. Chinese Medicine Modern Distance Education of China. 2016(18):72-4.
An D-w, Liu Y. Effect of Taohe Chengqi decoction with acupuncture and massage in preventing deep vein thrombosis after knee arthroplasty in rheumatoid arthritis. Chinese Journal of Thrombosis and Hemostasis. 2021:576-7.
Salarvand S, Heidari ME, Farahi K, Teymuri E, Almasian M, Bitaraf S. Effectiveness of massage therapy on fatigue and pain in patients with multiple sclerosis: A systematic review and meta-analysis. Multiple Sclerosis Journal - Experimental, Translational and Clinical. 2021;7(2):20552173211022779.
Ozdelikara A, Alkan SA. The effects of reflexology on fatigue and anxiety in patients with multiple sclerosis. Altern Ther Health Med. 2018;24:8-13.
Zhang T, Yan HX, An Y, Yin L, Sun PP, Zhao JN, et al. The Efficacy and Safety of Manual Therapy for Symptoms Associated with Multiple Sclerosis: A Systematic Review and Meta-Analysis. J Integr Complement Med. 2022;28:780-90.
Marinova D, Angelcheva M, Marinov T, Ignatov I. Influence of tuina therapy on pain as regards quality of life among patients suffering from multiple sclerosis. Journal of Medicine, Physiology and Biophysics. 2019;52:1-6.
Siev-Ner I, Gamus D, Lerner-Geva L, Achiron A. Refiexology treatment relieves symptoms of multiple sclerosis: a randomized controlled study. Mult Scler. 2003;9:356-61.
Li B, Liu H, Li C, Yang M, Zhang T. Combined Tui na and Western medicine treatment improves pulmonary function and quality of life in patients with amyotrophic lateral sclerosis: A case report. Medicine. 2023;102(16): e33612 PMID: 37083797
Zhao J-j. Treatment of ankylosing spondylitis by fire-needle therapy plus tuina manipulations. Journal of Acupuncture and Tuina Science. 2015;13:15-21.
Gui-yi D, Jian-hui H, Xing-mu Z, Jia-wei H, Zeng-sheng W, Yue-hui Q. Effects of acupuncture plus spinal manipulations on physical functioning and biochemical indicators in patients with ankylosing spondylitis. Journal of Acupuncture and Tuina Science. 2021;19:206-12.
Zou G, Wang G, Li J, Wu G, Huang J, Huang S. Danger of injudicious use of tui-na therapy in ankylosing spondylitis. Eur Spine J. 2017;26:178-80.
Szekanecz Z, Koch A, Tak P. Chemokine and chemokine receptor blockade in arthritis, a prototype of immune-mediated inflammatory diseases. Neth J Med. 2011;69:356-66.
Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, et al. Rheumatoid arthritis. Nat Rev Dis Primers. 2018;4:18001. PubMed PMID: 29417936
Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Res. 2018;6:15. PubMed PMID: 29736302
Jang S, Kwon EJ, Lee JJ. Rheumatoid arthritis: pathogenic roles of diverse immune cells. Int J Mol Sci. 2022;23(2):905. PubMed PMID: 35055087
Lundkvist J, Kastäng F, Kobelt G. The burden of rheumatoid arthritis and access to treatment: health burden and costs. Eur J Health Econ. 2008 Jan:8 Suppl_ 2:S49-60.
Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197-223.
Kitas GD, Gabriel SE. Cardiovascular disease in rheumatoid arthritis: state of the art and future perspectives. Ann Rheum Dis. 2011;70:8-14.
Jurcuţ C, Jurcuţ R, Tănăsescu C. Cardiovascular risk and rheumatoid arthritis: from mechanisms of atherosclerosis to therapeutic approach. Rom J Intern Med. 2004;42:659-69.
Sokka T, Kautiainen H, Pincus T, Verstappen SM, Aggarwal A, Alten R, et al. Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA study. Arthritis Res Ther. 2010;12(2):R42. PubMed PMID: 20226018
Kirkeskov L, Bray K. Employment of patients with rheumatoid arthritis - a systematic review and meta-analysis. BMC rheumatology. 2023;7:41. PMID: 37964371
Huang J, Fu X, Chen X, Li Z, Huang Y, Liang C. Promising therapeutic targets for treatment of rheumatoid arthritis. Front Immunol. 2021;12:686155. PMID: 34305919
Schattner A. The Cardiovascular Burden Of Rheumatoid Arthritis - Implications For Treatment. Am J Med. 2023;136:1143-6.
Teng HL, Chen KL, Chen SL. [The species basis of Berchemia lineata and its drug commodity]. Zhong Yao Cai. 2010 May;33:674-7.
Li J, Deng G-R, Cheng W, He B, Zhang G-L, Huang B-S, et al. Chemical constituents of berchemia lineata. Medicine and Biopharmaceutical: WORLD SCIENTIFIC; 2015. p. 1140-8.
Togari N, Ogawa N, Sakata T. Poor fermentability of “mekabu” (sporophyll of Undaria pinnatifida) alginic acid in batch culture using pig cecal bacteria. J Nutr Sci Vitaminol (Tokyo). 1995;41:179-85.
Chun-peng Z, Tian CAO, Xue Y. Pharmacological mechanisms of Taohe Chengqi decoction in diabetic cardiovascular complications: a systematic review, network pharmacology and molecular docking. Heliyon. 2024;10(13):e33308. PubMed PMID: 39044965
Wang N-h, Jun L, Pei M. Analgesia effect of tuina on pain of experimental rheumatoid arthritis rabbits. Journal of Liaoning University of Traditional Chinese Medicine. 2007(6).
Patrick RP, Johnson TL. Sauna use as a lifestyle practice to extend healthspan. Exp Gerontol. 2021;154: 111509. PubMed PMID: 34363927
Basso JC, Suzuki WA. The effects of acute exercise on mood, cognition, neurophysiology, and neurochemical pathways: a review. Brain Plasticity. 2017;2:127-52.
Hayashi T, Watanabe C, Katsuyama S, Agatsuma Y, Scuteri D, Bagetta G, et al. Contribution of histamine to nociceptive behaviors induced by intrathecally administered cholecystokinin-8. Frontiers Pharmacol. 2020;11:590918. PubMed PMID: 33250769
Pilozzi A, Carro C, Huang X. Roles of -endorphin in stress, behavior, neuroinflammation, and brain energy metabolism. Int J mol Sci. 2020;22(1):338. PubMed PMID: 33396962
Meng AH, Ling YL, Zhang XP, Zhang JL. Anti-inflammatory effect of cholecystokinin and its signal transduction mechanism in endotoxic shock rat. World J Gastroenterol. 2002;8:712-7.
Ye S, Shi K, Xu J, Wang M, Li CJ. Cholecystokinin octapeptide inhibits the inflammatory response and improves neurological outcome in a porcine model of cardiopulmonary resuscitation. Exp Ther Med. 2018;15:2583-8.
Swanberg KM, Kurada AV, Prinsen H, Juchem C. Multiple sclerosis diagnosis and phenotype identification by multivariate classification of in vivo frontal cortex metabolite profiles. Sci Rep. 2022;12(1):13888. PubMed PMID: 35974117
Baecher-Allan C, Kaskow BJ, Weiner HL. Multiple Sclerosis: Mechanisms and Immunotherapy. Neuron. 2018;97:742-68.
Lublin FD, Häring DA, Ganjgahi H, Ocampo A, Hatami F, Čuklina J, et al. How patients with multiple sclerosis acquire disability. Brain. 2022;145:3147-61.
G. B. D. Multiple Sclerosis Collaborators. Global, regional, and national burden of multiple sclerosis 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:269-85.
Lorefice L, Mellino P, Fenu G, Cocco E. How to measure the treatment response in progressive multiple sclerosis: Current perspectives and limitations in clinical settings’. Mult Scler Relat Disord. 2023;76:104826. PubMed PMID: 37327601
Cárdenas-Robledo S, Lopez-Reyes L, Arenas-Vargas LE, Carvajal-Parra MS, Guío-Sánchez C. Delayed diagnosis of multiple sclerosis in a low prevalence country. Neurol Res. 2021;43:521-7.
National Institute of Neurological Disorders and Stroke. Amyotrophic Lateral Sclerosis (ALS): National Intitute of Health. [Internet]. [cite 28 Nov 2024]. [Available from: https://www.ninds.nih.gov/health-information/disorders/amyotrophic-lateral-sclerosis-als
Ms S, Banerjee S, D’Mello SR, Dastidar SG. Amyotrophic lateral sclerosis: focus on cytoplasmic trafficking and proteostasis. Mol Neurobiol. 2025;62:10091-117.
Yousefian-Jazi A, Seol Y, Kim J, Ryu HL, Lee J, Ryu H. Pathogenic genome signatures that damage motor neurons in amyotrophic lateral sclerosis. Cells. 2020; 9(12):2687. PubMed PMID: 33333804
Vickers A, Zollman C. ABC of complementary medicine. Massage therapies. BMJ. 1999;319(7219):1254-7.
Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med. 2005;35:235-56.
Schwager S, Detmar M. Inflammation and Lymphatic Function. Front Immunol. 2019;10:308. PubMed PMID: 30863410
Vairo GL, Miller SJ, McBrier NM, Buckley WE. Systematic review of efficacy for manual lymphatic drainage techniques in sports medicine and rehabilitation: an evidence-based practice approach. J Man Manip Ther. 2009;17(3):e80-9.
Xing XX, Zheng MX, Hua XY, Ma SJ, Ma ZZ, Xu JG. Brain plasticity after peripheral nerve injury treatment with massage therapy based on resting-state functional magnetic resonance imaging. Neural Regen Res. 2021;16:388-93.
Chang KM, Luo SY, Chen SH, Wang TP, Ching CT. Body massage performance investigation by brain activity analysis. Evid Based Complement Alternat Med. 2012;2012:252163. PubMed PMID: 22518194
Yin L, An Y, Chen X, Yan H-x, Zhang T, Lu X-g, et al. Local vibration therapy promotes the recovery of nerve function in rats with sciatic nerve injury. J Integr Med. 2022;20:265-73.
Zhu W, He X, Cheng K, Zhang L, Chen D, Wang X, et al. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res. 2019;7:22. PMID: 31666997
Lindström U, Olofsson T, Wedrén S, Qirjazo I, Askling J. Impact of extra-articular spondyloarthritis manifestations and comorbidities on drug retention of a first TNF-inhibitor in ankylosing spondylitis: a population-based nationwide study. RMD Open. 2018;4(2):e000762. PubMed PMID: 30402269
Moltó A, Nikiphorou E. Comorbidities in spondyloarthritis. Front Med. 2018;5:62. PubMed PMID: 29594122
Simone D, Al Mossawi MH, Bowness P. Progress in our understanding of the pathogenesis of ankylosing spondylitis. Rheumatology (Oxford). 2018;57(suppl_6):vi4-vi9.
Garcia-Montoya L, Gul H, Emery P. Recent advances in ankylosing spondylitis: understanding the disease and management. F1000Res. 2018;7:1000 PubMed PMID: 30345001
Riancho JA. Diagnostic approach to patients with low serum alkaline phosphatase. Calcif Tissue Int. 2023;112:289-96.
Boyce BF, Xing L. Biology of RANK, RANKL, and osteoprotegerin. Arthritis Res Ther. 2007;9 Suppl 1(Suppl_ 1):S1. PubMed PMID: 17634140
Tishkowski K, Gupta V. Erythrocyte Sedimentation Rate. Treasure Island (FL): StatPearls Publishing; 2024.
Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front Immunol. 2018;9:754. PubMed PMID: 29706967
Han JS. Acupuncture and endorphins. Neurosci Lett. 2004;361:258-61.
Kaada B, Torsteinbø O. Increase of plasma beta-endorphins in connective tissue massage. Gen Pharmacol. 1989;20:487-9.
Bender T, Nagy G, Barna I, Tefner I, Kádas E, Géher P. The effect of physical therapy on beta-endorphin levels. Eur J Appl Physiol. 2007;100:371-82.
Zhang R, Lao L, Ren K, Berman BM. Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology. 2014;120:482-503.
Wang N, Zhao L, Zhang D, Kong F. Research progress on the immunomodulatory mechanism of acupuncture in tumor immune microenvironment. Front Immunol. 2023;14:1092402. PubMed PMID: 36865562
Pach D, Piper M, Lotz F, Reinhold T, Dombrowski M, Chang Y, et al. Effectiveness and cost-effectiveness of tuina for chronic neck pain: a randomized controlled trial comparing tuina with a no-intervention waiting list. J Altern Complement Med. 2018;24:231-7.





