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Bone-setting manipulation refers to the use of both hands to position injured tendons and bones, restoring them to their original state. However, injuries vary in severity, and different manipulative techniques have specific indications. The speed of recovery and whether physiological disabilities remain depend entirely on whether the manipulation is applied appropriately; if it is improper or the method is not fully mastered, outcomes may be compromised. Since the skeletal structure of the body is not uniform, and the arrangement and affiliation of the twelve tendon channels (Twelve Jing-Tendons) differ, one must be familiar with bodily morphology and anatomical locations beforehand. Upon clinical examination, external tactile stimuli trigger internal ingenuity; the hand moves with the mind, and techniques emerge from the hand. One may pull dislocated parts to recombine them, push displaced parts to restore alignment, correct obliquity, or repair defects. Whether bones are severed, comminuted, or obliquely fractured, or whether tendons are lax, elongated, curled, contracted, flipped, twisted, separated, or reunited—even when located deep within the musculature—palpation allows the practitioner to ascertain the condition clearly. When the applied technique causes no pain to the patient, it qualifies as proper bone-setting manipulation. Moreover, since many injury sites are vital to life—for example, the seven orifices connect to the brain marrow, the diaphragm is near the Heart (the Sovereign Mind), and injuries to the four extremities cause pain that affects the mind—even if the patient’s Yuan Qi (Original Qi) is robust and blood stasis disperses easily allowing for timely recovery, manipulation must not be applied recklessly. If Yuan Qi is inherently weak, an injury may already be critical; if manipulation is then performed incorrectly, recovery becomes nearly impossible. This is why extreme caution is required. A bone-setter must possess mental clarity and dexterous hands, understanding the pathology while skillfully applying manipulation, thereby ensuring therapeutic efficacy. Indeed, the hand, being flesh and blood, possesses subtle maneuverability through flexion and extension, elevation and depression, speed and slowness, lightness and heaviness, opening and closing. These movements can address qi and blood stagnation, swelling and pain in skin and flesh, and contracture and fracture of tendons and bones, as well as emotional distress. Compared to using rigid instruments for fixation, this approach is vastly superior. Thus, manipulation is indeed the primary task in bone-setting.

Palpation Method: Palpation involves carefully feeling the injured area with the fingers to determine if there is a bone fracture, comminution, deviation, integrity, softness, hardness, tendon tension, flaccidity, deviation, straightness, rupture, displacement, thickening, flipping, coldness, or heat, as well as assessing exterior-interior deficiency-excess patterns and the chronicity of the condition. First, determine if the cause is a fall, sprain/twist, or blow, then treat according to the appropriate method.

Apposition Method: Apposition refers to bringing broken bones together to restore their original continuity. For dislocations or fractures where bones are split apart, depressed, shattered, or protruding abnormally, observe the situation and gently reduce the fracture, reconnecting severed ends, elevating depressed fragments, consolidating shattered pieces, and flattening protrusions. This may be done via manual manipulation alone, with instruments alone, or a combination of both in sequence, depending on the physician’s adaptability.

Elevation Method: Elevation involves securing the target area with one or both hands, judging the force required, and lifting either from below upwards, from outside inwards, vertically or obliquely. When a bone is displaced, manual elevation is necessary so that the fracture line heals quickly without prolonged immobilization. The alignment must be precise to prevent limb length discrepancy after healing.

Lifting Method: Lifting refers to raising depressed bones back to their normal position. Methods vary: some use two hands to lift directly, others use ropes tied at higher points for traction, and some employ post-lift instrumentation to prevent recurrence. Treatment must be tailored to the depth and severity of the injury. Over-lifting severe injuries will fail to cure, while under-lifting minor injuries may resolve the old problem but create new ones.

Massage Method: "An" (Pressing) means pressing down with the hand. "Mo" (Rubbing) means slowly kneading. This method is indicated for injuries to skin and muscles presenting with swelling, induration, and numbness, provided the bone is intact. It is also used for subluxations caused by falls or twists, where joint spaces are misaligned, leading to qi and blood stagnation, swelling, and pain. Pressing the meridians unblocks stagnant qi, while rubbing dissipates accumulated masses and resolves blood stasis swelling, leading to recovery.

Pushing and Grasping Method: "Tui" (Pushing) means pushing with the hand to return tissues to their original position. "Na" (Grasping/Pinching) involves pinching the affected area with one or both hands, adjusting pressure gently to restore alignment. If swelling and pain have subsided and wounds have healed, but tendon tightness limits rotation or tendon laxity restricts movement, or if slight joint misalignment persists despite apparent healing, manipulation methods like apposition, reduction, elevation, or lifting are contraindicated. Instead, pushing and grasping should be used to promote the circulation of qi and blood through the meridians. Given the distinction between major meridians and collateral vessels, pushing and grasping can be adjusted based on deficiency or excess to apply tonifying or draining techniques, ensuring patient recovery.

The above outlines the general principles of these eight methods. Clinical judgment and momentary ingenuity rely on the individual practitioner’s wisdom and experience.