The Practice of Gua Sha for Weight Loss Based on Differentiation of Syndromes: Targeting the Type of Heat Accumulation in the Spleen and Stomach and Phlegm-Dampness Accumulation

Rolling the lower limbs: The practitioner makes a loose fist and uses the knuckles of the back of their hand to repeatedly roll and press on the outer side of the patient's thigh, focusing on the muscular areas at the front of the thigh, aiming for a localized sensation of soreness, numbness, and distension. Palm pushing the lower limbs: The practitioner uses the heel of their palm on the back of the patient's lower limbs, pushing from the root of the thigh to the distal end of the calf. The force should be even and strong, continuous, and slow. Tapping the lower limbs: The practitioner makes a loose fist and taps the patient's lower limbs with the ulnar side of their palm, along the front of the thigh and between the tibia and fibula of the lower leg. The tapping force should be strong, within a tolerable range.

Walk in a straight line, tapping at intervals of 1-2 inches. Shaking the lower limbs: The practitioner holds the patient's ankles with both hands and gently shakes them up and down; the shaking should be light, not forceful. Twisting the toes: The practitioner uses the pads of their thumb and index and middle fingers to pinch the patient's toes, twisting and kneading from the base of the toes to the tips. Do not use too much force when twisting the toes, and the rotation angle should not exceed 45°. Excessive force or too large a rotation angle can cause pain or sprains. Pulling the toes: The practitioner uses the pads of their thumb and index finger to pinch the patient's toes and slide them towards the tips.

Pulling and stretching: pinch the base of the toes with your fingers and then slide down to the tip of the toes. Sometimes you can hear a cracking sound as the joints open. If not, do not force the pulling and stretching. [Common acupoints and locations] The lower limbs are traversed by the three Yin meridians and three Yang meridians of the foot. Since the Yang meridians are rich in Qi and blood, draining the Yang meridians and tonifying the Yin meridians can have a slimming effect. Commonly used acupoints are those of the Yangming and Taiyang meridians. Main acupoints: Cilao, Huantiao, Biguan, Xuehai, Fengshi, Chengfu, Chengshan, Yinmen, Weizhong, Zusanli, Sanyinjiao, Yongquan. [Location of acupoints] (1) Cilao: In the sacral region, below and inside the posterior superior iliac spine, directly opposite the second posterior sacral foramen.

(2) Huantiao: On the lateral aspect of the thigh, with the patient lying on their side and the thigh flexed, at the junction of the outer 1/3 and middle 1/3 of the line connecting the most prominent point of the greater trochanter of the femur and the sacral hiatus. (3) Biguan: On the anterior thigh, on the line connecting the anterior superior iliac spine and the lateral end of the patella, level with the perineum when the thigh is flexed, in the depression lateral to the sartorius muscle. (4) Xuehai: With the knee flexed, on the medial aspect of the thigh, 2 cun above the medial end of the patella, at the prominence of the medial head of the quadriceps femoris muscle. (5) Fengshi: On the midline of the lateral aspect of the thigh, 7 cun above the popliteal crease, or at the tip of the middle finger when standing upright with arms hanging down. (6) Chengfu: On the posterior aspect of the thigh, at the midpoint of the gluteal crease.

(7) Chengshan: When the lower leg is straightened or the heel is raised, the depression at the lower apex of the gastrocnemius muscle belly. (8) Yinmen: On the line connecting Chengfu and Weizhong, 6 cun below Chengfu. (9) Weizhong: At the midpoint of the popliteal crease, between the tendons of the biceps femoris and semitendinosus muscles. (10) Zusanli: On the anterolateral aspect of the lower leg, 3 cun below Dubi, one finger-width away from the anterior border of the tibia. (11) Sanyinjiao: 3 cun above the tip of the medial malleolus, behind the medial border of the tibia. (12) Yongquan: When the foot is curled up, in the depression at the front of the foot, at the junction of the anterior 1/3 and posterior 2/3 of the line connecting the tip of the second and third toes and the foot.

Operating Procedure: [Relaxation Techniques] **Lower Limb Massage:** The practitioner uses the palm of their hand to massage the back of the patient's lower limbs from top to bottom, repeating 2-3 times. **Lower Limb Lateral Roll:** The practitioner uses the back of their hand to roll the patient's lower limbs laterally. The rolling motion should be stronger than the palm massage, penetrating the muscle layer and above the bones. Roll firmly but slowly, applying pressure until a slight soreness is felt in the muscles, repeating 2-3 times from top to bottom. **Chengfu Acupoint Press:** The practitioner uses the pad of their thumb to press and knead the Chengfu acupoint (located at the transverse crease below the buttocks) on the patient's thigh.

If the pressure is insufficient, use the tip of your elbow to press. Apply greater pressure to the Chengfu acupoint, aiming for a feeling of heaviness and distension in the area. Repeat this rubbing motion 10-20 times or for 1 minute. Press the Yinmen acupoint: The practitioner uses the pad of their thumb to rub and press the Yinmen acupoint on the back of the patient's thigh. If the pressure is insufficient, use the tip of your elbow. Repeat this 10-20 times or for 1 minute. Press the Weizhong acupoint: The practitioner uses the pad of their thumb to rub and press the Weizhong acupoint in the center of the patient's popliteal fossa. Repeat this 10-20 times or for 1 minute. Do not press the Weizhong acupoint too forcefully to avoid causing patellar pain.

Pressing the Chengshan acupoint: The practitioner uses the pad of their thumb to knead and press the Chengshan acupoint on the center of the patient's lower leg, repeating 10-20 times or for 1 minute. The Chengshan acupoint is quite sensitive, so too much force should not be used to avoid causing severe pain. Pressing the Sanyinjiao acupoint: The practitioner uses the pad of their thumb to knead and press the Sanyinjiao acupoint on the inner side of the patient's lower leg, repeating 10-20 times or for 1 minute. Pressing the Yongquan acupoint: The practitioner uses the pad of their thumb or middle finger to press the Yongquan acupoint on the sole of the patient's foot, repeating for 1 minute. The pressure on the Yongquan acupoint can be firm, ideally producing a slight pain.