Reflexology: The Definitive Practitioner's Manual: Recommended by the International Therapy Examination Council for Students and Practitoners

Egyptian origins

The Egyptian origins of reflexology can be seen in a frieze at the tomb of Ankhmahor that is thought to illustrate a reflexology treatment taking place (figures 1.1 and 1.2). This tomb in Saqqara is known as the ‘physician’s tomb’ owing to the marvellous portrayal of many medical scenes found on its walls. The tomb was discovered by V Loret in Egypt in 1897. Saqqara is one of the richest archaeological sites in Egypt, containing monuments constructed over a span of more than 3,000 years, the earliest being the Mastabas, the earlier name for a tomb. Saqqara is the largest necropolis found (a large burial ground of the ancient city). Activity was extremely intense in this area during the Old Kingdom.

The Old Kingdom encompassed the period from the 1st to the 6th Dynasty when all the great pyramids were built in Giza and in Saqqara this period lasted from 3000 to 2250 BC when it came abruptly to an end, owing to a civil war breaking out, and the whole empire collapsed. To the Ancient Egyptians the afterlife was just as important as the earthly life, hence the reason they surrounded themselves with many murals and pictures on the walls of their many tombs; these portray agricultural scenes and abundant harvests as well as hunting, fishing and dancing scenes and many games. All of these were of an afterlife modelled on a visionary earthly life. Ankhmahor was an able master-builder and was considered an expert because he controlled the work of the many sculptors at the tomb. This project disclosed his keen interest in medicine as he displayed recurrent images of medical themes and surgical operations taking place on the walls. His interest in pathology was attributed to his admiration of another architect named Imhotep, who was made an object of worship and was later known as Imuthes, God of Medicine. (Imhotep built the first step pyramid for King Zoser the Pharaoh of the 3rd Dynasty in 2686 BC when Zoser was the King of Upper and Lower Egypt.)

Figure 1.1 Illustration of patients having hands and toes treated (lower picture) and a patient having hand treatment (top picture), from the tomb of Ankhmahor.

In the Masataba of ‘Ankhmahor’ on the west door entrance are two registers representing the treatment of hands and feet. These are referred to as a manicure and pedicure by Alexander Badawy in his book The Tomb of Ankhmahor at Saqqara in which he gives a very fine detailed translation of the wall scenes. In one scene on the wall the right hand of one person is being treated and the other person is having a toe on the left foot treated. The text reads: (patient) ‘Make these give strength.’ The operator responds, ‘I will do to thy pleasure sovereign!’ (This answer is between the two operators, so it could be valid for both.) The patient who is having his toe treated is begging, ‘Do not cause pain to these.’ There also appears to be a probe in the operator’s hand (see figure 1.1) (although this is not shown in the many reproduced copies that are included in many reflexology books). An upper fragment on the same wall shows a patient having both hands treated; however, the inscription was badly defaced (see figure 1.1).

Figure 1.2 Patients having massage or manipulation of the foot or leg and shoulder, from the tomb of Ankhmahor.

Another relief shows massage or manipulation to the foot or leg and shoulder (figure 1.2), which could indicate some form of pressure therapy. As massage was often mentioned in many of the texts and old medical papyri it is quite reasonable to believe that this could be a form of reflexology treatment taking place on the hands and feet with massage or manipulation to the legs and back.

Ankhmahor himself is represented on two door-jambs in identical striding attitude. The inscriptions indicate the many titles he held; these include ‘Hereditary Prince’, ‘Count’, ‘Chief Justice’, ‘Vizier’ and ‘Court Physician’.

Chinese origins

Ancient Chinese writings described a pressure therapy using the fingers and thumbs. Acupressure is an old Oriental therapy, ‘acu’ meaning ‘needle point’; however, finger pressure was used long before needles. There are different types of acupressure, from the very gentle to deep digital and thumb pressure. There were many early books written on massage or ‘examining foot method’ as it was then called. In reflexology, the varying pressures are used according to each individual’s requirements and the diagnostic techniques are very similar to those used in Chinese acupressure.

In the Sung Dynasty (AD 960–1280) a paper that first appeared in Essentials of Preserving Life showed some exercise routines, which, when repeated, were supposed to be excellent for health. One of these routines was to stretch the hands forward and clench firmly the balls of the extended feet and lower the head as if paying homage; this was repeated 12 times, after which you then returned to the crossed leg position and placed your clenched hands back into your lap. Many ancient diagrams survived of these early ‘Dao Yin’ exercises that were the earliest forms of Chi Kung (Qigong); these were traditionally considered representations from the Chinese ancients of longevity each of whom had their own special method of healing diseases. One in particular is an acupressure cure for lumbago or any low back pain; it shows the person facing the wall, pressing the palm of the right hand against the wall, letting the left hand drop naturally; the right foot is also placed against the wall, and the person then proceeds to exhale very slowly 18 times. This is then repeated with the left hand and foot. This exercise is claimed to heal strain of the lumbar muscles, and relieve lower back pain and lumbago. These actions indicate how important the hands and feet are considered to be in maintaining good health in TCM.

Acupuncture itself developed throughout the early Shang Dynasty in the 16th to 11th centuries BC. It became a method of treating disease and pain by the insertion of many different types and sizes of needles into specific areas of the body. These areas, or acupuncture points (acupoints), were thought to lie on lines or channels known as meridians (see chapter 2 for a full description). Acupressure and acupuncture were, however, only a small part of the treatment of TCM. The system also included a vast herbal tradition and dietary practices.

Buddhism was a religion of East and Central Asia that grew from the teachings of Gautama Buddha. His philosophy was that pureness of spirit was the answer to all suffering. Buddhism spread to China around the time of the Han Dynasty (about 206 BC). There is evidence from this period that in ancient times the feet symbolized many things. A Buddha’s footprints carved in the rock at Kusinara, China, shows signs on the second, third, fourth and fifth toes depicting the Sun, in ancient times possibly symbolizing the Qi energy within the toes (see figure 1.3).

Yin, Yang and Qi

The terms ‘Yin’ and ‘Yang’ are widely used in Traditional Chinese Medicine. They describe, for instance, the quality of the Qi (Chi) energy, which flows through channels called meridians. Illness is caused by an imbalance of Yin and Yang in the body. The idea of Yin and Yang polarities appears continually throughout Chinese thought. Yin is conceived as the soft, inactive female principle or polarity in the body and in the universe generally, while Yang is the active, male principle or polarity. Although opposites, they are also interrelated, and to keep healthy these two opposing but complementary energies must always be balanced.

One energy ascends in the body; the other descends. TCM theory states that if the blood and the energy are not in equilibrium, there is disharmony between the Yin and Yang qualities, and illness will soon follow. A blockage or malfunction is considered to indicate a deficiency or excess of energy of one or the other within the body, manifesting as a functional disturbance, or an imbalance in the way in which an organ or body system functions; from this, physical ill-health can develop. A saying that describes this idea is ‘If there is a kink in the life force disease will manifest’. In disease these terms also refer to Yang being all acute problems, in which the patient feels hot and may have a temperature, and is restless. Yin indicates a more chronic problem, in which the patient is weak and often cold and has no wish to move about.

Figure 1.3 Buddha’s foot, showing the Sun sign on the toes, possibly indicating Qi.

Good health depends on the correct balance between these two opposites, the negative and positive. To follow the general principles of Yin and Yang one needs also to be aware of the environment and the changes of the season; all of the above had to be taken into consideration to preserve life. Today China is known for its many centenarians, and longevity is something all Chinese people cherish; many feel that it can be attained through correct living and the use of TCM principles.

The Zang-fu organs and the meridians

TCM theory divides the body into 12 organ systems, 6 of which are Yang (Fu or hollow organs): Stomach, Small Intestine, Large Intestine, Bladder, Gall Bladder and Triple Burner (or Triple Heater or Triple Energizer), and 6 of which are Yin (Zang or solid organs): Heart, Liver, Spleen (and Pancreas), Lungs, Kidneys and Pericardium. Together they are called the Zang-fu.

Each of the Zang organs is related to one of the Fu organs. So there are six pairs. Often when treating a patient, these Yin and Yang organs can be coupled together because they are so closely related, and treatment of one will often affect the other. The pairs are: the Liver and Gall Bladder, the Spleen and Stomach, the Lungs and Large Intestine, the Kidneys and Bladder, the Heart and Small Intestine, and the Pericardium and Triple Burner. The Triple Burner (Sanjiao) regulates the functioning of all the Zang-fu organs; it also acts as a passageway for the movement of all fluids.

The organs are also designated according to the Five Elements theory. According to ancient Chinese traditions, the elements comprise Wood, Fire, Earth, Metal and Water. These elements are thought to influence each other, in a cyclical manner.

The balance of Yin and Yang within each of the above organ systems is regulated and influenced by the Yin-Yang balance of the Qi flowing through the meridians connected with them. This Qi is particularly easy to influence for the purposes of treatment at particular points called acupuncture points (or acupoints). Acupoints at the extremities (hands and feet) are thought to be the most powerful to use (see figure 1.9).

There are 12 major meridians in the body and limbs, each connected to one organ system; 6 connect the hands with the face or chest, and 6 connect the feet with the face or chest. These meridians are often classified in three ways:

1. According to their cycle of energy. This is as follows: Lungs, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidneys, Pericardium, Triple Burner, Gall Bladder, Liver. The cycle of energy goes: hands-hands, feet-feet, hands-hands, feet-feet, hands-hands, feet-feet; we can balance the energy by working on this theory.

2. According to the division of the two groups into Yin and Yang: the Yin meridians of the feet and legs are: the Liver, Spleen and Kidneys – these ascend from the feet to the breast (figure 1.4) the Yin meridians of the hands and arms are: Lungs, Heart, Pericardium – these descend from the breast to terminate in the fingers (figure 1.5) the Yang meridians of the hands and arms are: Large Intestine, Small Intestine and Triple Burner – these ascend from the fingers to the face (figure 1.6) the Yang meridians of the feet and legs are: the Stomach, Bladder, Gall Bladder – these descend from the face to the toes (figure 1.7).

3. According to where they are located: the six meridians on the hands and arms include the Lungs, Large Intestine, Pericardium, Triple Burner, Heart and Small Intestine. The six meridians on the feet and legs are the Kidneys, Spleen, Liver, Stomach, Gall Bladder and Bladder.

There is an involved association between an organ and a meridian. They are often paired together because of the anatomical closeness of the corresponding meridian, which links the Yin and the Yang organ. In reflexology this opposite point becomes an area of assistance to work.

We begin to see a combination between the groups as follows:

• The three Yin meridians descend from the breast area to the hands (see figure 1.5); that is the Lungs, Heart and Pericardium, (for details of each meridian pathway see figures 2.8–2.20).

• The three Yang meridians of the hands ascend from the hand to the face (see figure 1.6) that is the Large Intestine, Small Intestine and Triple Burner.

• The three Yin meridians of the feet ascend from the feet to breast area (see figure 1.4); that is the Spleen, Kidneys and Liver.

• The three Yang meridians of the feet descend from the face to the feet (see figure 1.7); that is the Stomach, Bladder and Gall Bladder.

Figure 1.4 The three ascending Yin meridians of the feet (Spleen, Liver and Kidneys)

Figure 1.5 The three descending Yin meridians of the hands (Lungs, Heart and Pericardium)

Figure 1.6 The three ascending Yang meridians of the hands (Large Intestine, Triple Burner and Small Intestine)

Figure 1.7 The three descending Yang meridians of the feet (Stomach, Bladder and Gall Bladder)

Figure 1.8 (a) Eight major meridians converge on the face. (b) The face has three originating points, three terminating points, and two terminating points from the vessels.

There are many interactions between the organs and meridians, and they are paired in many ways. Some old doctrines link the Yin organs in a cycle, and then the Yang organs, in a theory that attempts to describe the movement of Qi energy. One idea is that there is an area of the body where Qi undergoes a fundamental change in polarity, where Yin is converted into Yang or vice versa (figure 1.9). One speculation is that at such an area or point the therapist gets a much more positive result, because the energy is unstable and nearer to the surface here. However, there are areas which contain the points where the ascending Yang meridians terminate on the face and where the descending Yang meridians originate from prior to descending to the feet: these are thought to be more stable yet not so potent. Yet if this is so, why is it that these facial distal points are so powerful? It is important to note that there are eight major meridians converging on the facial area (see figures 1.8a and 1.8b, and chapter 7). Is this why the ears, head and facial points are so effective? This interchange of energies takes place on the fingers of the upper limbs as the Yin energy is near its end, and the Yang energy is about to commence; this fluctuation extends from the fingers to the elbow. So we see the three Yin meridians conveying their energy to the three Yang meridians, anywhere in this area. This leads to the traditional pairing of these organs on the hand:

• Lungs (Yin) paired with Large Intestine (Yang)

• Heart (Yin) paired with Small Intestine (Yang)

• Pericardium (Yin) paired with Triple Burner (Yang).

The same metamorphosis takes place on the feet, with the area from the tips of the toes to the knee being the most advantageous area to work, and around the ankles being very potent. Again, a pairing of the Yin and Yang meridians takes place:

• Stomach (Yang) paired with Spleen (Yin)

• Bladder (Yang) paired with Kidneys (Yin)

• Gall Bladder (Yang) paired with Liver (Yin).

It is important when treating always to balance these points, incorporating pressure points of both upper and lower limbs. This stabilizes the energy from the upper part of the body with that of the lower part of the body. The combination of such points is very forceful and effective, so working upper pressure points with lower pressure points or working on the paired organ becomes a powerful therapy.

The Chinese often utilize these combination points according to their forceful action or their compatibility. The meridian channels form a complete circuit and TCM principles state that these energies within each meridian are balanced; hence, on that account they have always been used in treatment. The points on the extremities are referred to as the fountain head or well points (figure 1.9), for instance those at the tips of the fingers and the tips of the toes, and KI-1 located at the centre of the ball of the foot. These are considered to be extremely powerful as they are barely skin deep at this terminal or starting point, so they are easy to stimulate by palpation as is done in reflexology. The spring points are extremely potent and forceful; these are found around the wrist and the ankles, with the feet points being more dynamic than those of the hands. At the sea points, which lie at the elbows or knees, the energy is more general and less active, achieving a slower response.

Recent history

When the People’s Republic of China was formed in 1949 TCM came under threat because of superstitions and ancient theories and was almost lost. It was Chairman Mao who came to the rescue. The story goes that he became very ill and orthodox medicine did not help him, so he turned to the traditional folk medicine, which saved him. Following this, he declared ‘Traditional Chinese Medicine is of immense value, it needs to be constantly explored and further developed’. Because of this, since 1950 work was encouraged on research and tests on TCM, and Western medicine and TCM were practised side by side. Research on TCM has continued in China and has been maintained over the last 40 years and more recently they have also researched treatment by reflexology. To date the China Reflexology Association have accumulated over 10,000 case histories on reflexology treatments. There are 31 provinces in China, half of which have set up a reflexology branch. Among 7,000 members of the national and the local associations, there are now over 1,500 medical doctors in China who practise reflexology in their hospitals, or clinics, sanatoriums, and other centres.

Figure 1.9 The most potent areas to work

The history of the zone concept

The founder of zone therapy

Zone therapy is a system discovered many years ago by an eminent American physician, William H Fitzgerald, who was born in 1872 and who died in Stamford, Connecticut on 21 October 1942. He was an MD in Hartford, Connecticut. Dr Fitzgerald graduated from the University of Vermont in 1895 and worked his first 21/2 years at the Boston City Hospital; he then went on to serve a further 2 years at the Central London Ear, Nose and Throat (ENT) Hospital in England (1902). This was followed by a further 2 years in Vienna’s ENT Hospital under Professor Politzer and Professor Otto Chiari, who were well known in the medical world at that time. All of this gives some indication of Dr Fitzgerald’s qualities as a doctor and surgeon. Dr Fitzgerald was senior nose and throat surgeon at St Francis Hospital, Hartford, Connecticut for several years. It was during that period that he made his findings of zone therapy, as it was called at this time, known to the medical world.

He developed this therapy because he observed, while working, that when applying pressure over certain points of the toes and hands, and other parts of the body, if the pressure was firm enough it caused a type of anaesthesia in a limited area. This enabled him to perform minor operations on the nose and throat without using cocaine and other local analgesics while the patient could be treated without pain. Fitzgerald stated in his book that pressure over any bony eminence, or upon the zones corresponding to the location of the injury, would tend to relieve pain, and that not only would it relieve pain but if pressures were firm enough it would produce an anaesthetic effect, often removing the cause of the pain.

Dr Fitzgerald published his first book in 1917 with Dr Edwin Bowers. The title read ‘Zone Therapy, or Relieving Pain at Home’. In this he related all his important findings on zone therapy. A zone is an area or part that is marked off, with stated qualities. Fitzgerald diagrammatically depicted this in his early drawings by dividing the human body into zones both anterior and posterior (figure 1.10) and he speculated that the body could be divided into ten such longitudinal (meaning vertical) zones, five each side of the median or middle line. The first ran from the medial edge of the great toe through the centre of the nose to the brain, and then out to the thumb or vice versa. He spoke of these zones as numbering one to five on the right side of the body and the same on the left side. He called them ‘ten invisible currents of energy through the body’ in line with the fingers and toes. (Note that the zones extended from the toe to the brain and out to the thumb or fingers or vice versa, not from the brain to the toe and brain to fingers, as stated in some books.) Fitzgerald also said that his five lines marked out and represented the centre of the respective zones. (Many books do not show this but instead depict four lines coming from each of the webs of the toes, showing the digits as the ten zones.) He then demonstrated the correlation between areas in distant parts of the body and how pressure of between 2 and 10 pounds on given fingers or toes would alleviate pain anywhere in a particular zone. He also stated that the upper and lower surfaces of the joint and side areas must all be pressed for good results (figure 1.11). Each zone could be worked on either hands or feet because the zones ran either way. The distance between the area treated and the organ was of no importance as the whole zone would be treated.

Fitzgerald outlined how pressure over the great toe or on the corresponding thumb helped the entire first zone; this first zone included the incisors and cuspid teeth, and an analgesic effect would often be felt throughout the zone. The second zone included the bicuspid and the third zone the two molars (knowing the zonal pathway enables you to work on the corresponding area for teeth problems). He stated that zones 4 and 5 usually merged in the head. The shoulder and axilla were in all five zones. Also he considered that in zone 4 was the middle ear. (My opinion is that the eustachian tube and middle ear combined are in zones 3 and 4.)