In ancient Chinese Medical Science, there are five levels of healing skills. The first is tuena. The healer uses his hands to massage. This is also called acupressure. This is the first level. In the second level, the medical healer uses herbs, sometimes animal products, and minerals to heal the patient. In the fourth level, the healer practices acupuncture with the projection of chi energy into the needles, meridians, and internal organs. This is a higher level of healing skill which which required additional years of training and practice in ancient China. The fifth level required the highest healing skill, which is the projection of chi energy without the use of needles or physical contact. The chi energy is projected at close range or at great distance, like from one continent to another continent. In ancient China and India, the technique of projecting chi energy at close range or at a distance without getting exhausted had been a closely guarded secret.