Qigong

Excerpt from:

Ross C. Qigong. In Lake, J and Spiegel, D (ed.),

Clinical Manual of Complementary and Alternative Treatments in Mental Health.

Washington, DC: American Psychiatric Press, Inc. 2006.

Qigong: historical context

For over 3000 years, qi-related exercises have been practiced in ancient China. These practices date back before the Shang dynasty (16th-11th c BC) and have been known by many names: daoyin (directing extremities), tuna (exhalation and inhalation) and lianqi (training of vital energy). Those living in the Imperial court were the first to practice qi-related exercises. The first recorded use of the term “qigong” was in 1956 by Liu Gui Zhen. (Ng)1 On mainland China, it is estimated that not less than 5% of people practice various forms of qigong daily to prevent illness, promote health and increase longevity. (Ng and Lake 2001)2 Worldwide, there are an estimated one hundred million practitioners of qigong.

Qigong (also spelled Ch'i Kung and pronounced chee gung) is philosophically linked to Traditional Chinese Medicine as one of four main modalities: acupuncture therapy, herbal remedies, Chinese massage (tuina), and medical qigong. Medical qigong is the oldest of these branches and forms the energetic basis for the other therapies. While most Westerners think of qigong as the series of exercises done by practitioners for the purpose of improving their own health and well-being and reaching spiritual transcendence, medical qigong involves externally emitted energy by a skilled medical qigong master for the purpose of healing others.

Modern laws of physics now support the interchangeable nature of matter and energy and may eventually explain scientifically the putative energetic mechanism of action associated with qi. Qi means “vital energy” or life force and gong means “skill.” So Qigong is the “skillful practice of gathering, circulating and applying life-force energy.” The ancient Chinese believed that all things in life, nature and the universe are connected energetically and that we are all symbiotically one with the universe through the system of qi or vital life energy. Qi is stored in the human body in reservoirs and flows through the body in mapped pathways or channels (called meridians). Qi can be divided into the five manifestations of matter and energy: mineral, plant, animal, human and divine. The five manifestations of qi can be sub-divided into the two equal and opposite aspects of Yin and Yang. 3(Johnson) Yin and Yang expressions of qi include the wilds of nature such as wind, rain and the cosmic influences of the moon and the stars as well as interpersonal energies at play in our families and communities. The medical application of this concept in TCM evolved to mean that good health involves a balance of both the yin and yang aspects of qi. As well, all other aspects of the practice of TCM involve yin and yang aspects: each sign or symptom of the disease process, the treatment plan the physician develops and the type of treatment chosen. A TCM diagnosis requires an analysis of Qi as it reflects the delicate balance or imbalance of yin and yang. (Holland)

Medical Qigong (includes externally applied qigong therapy or EQT and well as prescribed qigong exercises) involves the manipulation of qi for therapeutic purposes. The practitioners of this therapy are able to become aware of qi, use their minds or intent (yi) to manipulate and stimulate the qi of the patient without actually touching the patient, guiding the qi towards desired places in the body. The practice involves the emission of qi or the use of yi (consciousness or intent) or a combination of both. The practitioner uses techniques to rid patients of toxic pathogens or stores of old, painful emotions that cause mental and physical illness. These techniques include breathing with movement techniques, creative visualization, and spiritual intention to improve health and regain personal power and control of one's health. (Johnson) Most hospitals in China have qigong departments as well as herbal and acupuncture departments,4 however, controlled trials have failed to substantiate claims that EQT is effective, even in the People's Republic of China. The official position of the Chinese Ministry of Public Health since 1989 has been “not to publicize and not to deny.” There has also been a tightening of regulations governing the practice of medical qigong to protect the public against financial loss, to quell superstitions regarding qigong in the community and to have more control over qigong masters. (Tang, KC 1994)5

The philosophy of qigong as a self-healing exercise also involves bringing intention (yi) to direct the movement of qi or vital life energy in the body. Good health requires balance and balance derives from the proper movement and distribution of qi. The purpose of qi exercises is to both strengthen the body's qi and to remove blockages to the flow of qi that may be the result of emotions, injury, poor diet, or illness. (Sancier)6 Blockage of qi flow is thought to cause imbalance and disease or lack of harmony in the body and mind.

The practice of qigong includes postures, movement, self-massage and breathing techniques. Along with exercise, there is a meditative aspect of qigong. The ancient Chinese believed that the six healing sounds used in qigong correlate with specific meridians (channels along which qi flows) and organ systems, which are nourished and healed by the sounds. The qigong movements can be done in standing, seated or supine positions.(Ng)

There are two main qigong exercise techniques: neigong (internal exercise) and waigong (external exercise). Neigong is practiced in a meditative state with the practitioner focusing attention on the dan tien (“elixir field”) while inhaling, exhaling and holding the breath to stimulate qi and blood and strengthen the constitution. The dan tien are regarded as the three primary storage sites of jing, qi and shen. Qigong exercises are designed to correct imbalances in one or more of the dan tien, restoring the body to a state of optimum balance and health. Waigong involves qigong exercises, an example of which is Tai Ji Quan (traditional Chinese shadow boxing) which 'seeks quiescence within mobility.' (Ng) (Lake 2001) While qigong is considered a health exercise that forms the basis of TCM, tai chi, tai chi chuan or taiji originated from the martial arts. Tai chi is now practiced as an exercise for health maintenance but it maintains many of the original martial arts moves. While tai chi may have many self-healing benefits, it is not comparable to the medical form of qigong discussed above.

Research on qigong as a treatment of mental illness

Numerous studies have demonstrated psychological benefits from the consistent practice of qigong. The majority of studies done on qigong or tai chi have been done in the People's Republic of China. Some have been published in Chinese medical journals, many have been reported at qigong conferences and never subsequently published. Unfortunately, many studies are small and poorly designed, showing preliminary findings that need validation with larger, better designed studies. Other issues that interfere with efforts to study qigong have to do with difficulties inherent in adapting the traditional Chinese medical concept of qigong to the western research model, including the problem of finding identifying suitable sham treatments or sham qigong masters who cannot be distinguished (ie by study participants) from actual qigong masters.

Lake (2001) has reported on studies presented at conferences in China and never published, including the following:

1.  Three studies on qigong as a treatment of depression, one of which (Tang, et al)7 was presented at the 3rd National Conference on Qigong Science in 1990 was a double- blind study that showed evidence of efficacy. This study was done in an elderly population of 122 qigong practitioners and 55 participants who practiced Taijiquan compared to 90 age-matched controls who practiced neither qigong nor Taijiquan. The results demonstred an improvement in mood, reduction in anxiety and better “quality of sleep” in the intervention group. Two other studies showed significant findings and were presented at the 2nd World Conference and Academic Exchange on Medical Qigong. Wang8 found improvement in baseline psychological and emotional state correlated with duration of practice of qigong. In Schwartzman's9 (1998) study, 9 of 13 patients reported benefits from qigong with a 25-50% improvement in pre-treatment depressed mood. Both of these studies showed promising prospective data with significant trends requiring verification through future double-blind controlled studies.
2.  In the treatment of anxiety, five studies were identified, three of which are reviewed here. Of these, only one reported promising evidence of a significant therapeutic effect. This open prospective study Li, et al10 compared 35 qigong practitioners with age and gender matched controls who received biofeedback using electromyography, all of whom were diagnosed with anxiety, neurosis, headaches, etc. This study found that after two weeks of the intervention, overall measures of frequency and intensity of subjective stress indicators were decreased in male qigong practitioners as compared to the group receiving biofeedback. There were no significant differences in the group of females. In a prospective open study by Kato11 in Japan, twenty minutes of combined passive and active qigong exercises was undertaken by 13 subjects with a decrease in subjective feelings of anxiety. In a similar study (Shan, et al) 8 participants practiced the Fang Song Gong style of qigong fifteen minutes daily for one month. All met DSM-III criteria for generalized anxiety disorders. Findings included increased amplitude in alpha wave frequency of EEG, decreases in heart rate, blood pressure and oxygen consumption and significant decreases in anxiety as measured by the Hamilton Anxiety Scale (HAM-A). This study was limited by the small sample size, short study period, lack of long term follow-up and lack of a control group. A final study by Hutton, et al12 compared progressive muscle relaxation to Tai-Chi for treatment of generalized anxiety symptoms in veterans diagnosed with PTSD. Eight veterans were randomly assigned to the two intervention groups. Results included significant decreases in subjective distress in the Tai-Chi group with a trend towards lowered heart rate in the Tai-Chi group. Bias may have occurred from the greater compliance in the Tai-Chi group.
3.  An unpublished study in 1999, looked at the effects of qigong practice on “aggression, attention and restlessness” in elementary school-age children (Cousins)13. Qigong practice was conducted every Monday for two months. The teachers rated most children as less restless and more attentive during class on the day of qigong practice, but not on subsequent days. Many of the children reported feeling “full of energy.” This study was limited by lack of a control group, no blind raters and failure to measure pre and post-study changes in attention and aggression. There was no effort to diagnose ADHD or ADD in children in the classroom before starting the study.
4.  A randomized study on the efficacy of qigong to treat withdrawal symptoms in heroin addicts was undertaken by Li, Ming et al.14 Participants were randomly assigned to receive qigong treatment, medication for detoxification or symptomatic care only. Participants in the qigong treatment group practiced Pangu Gong style of qigong two hours daily and received emission (external) qigong treatment (EQT). Results of this study demonstrated a significant reduction in withdrawal symptoms, lower state anxiety and greater improvement in sleep quality in the qigong group compared to the other groups. All subjects in the qigong group had negative urine morphine levels by day 5 of treatment compared to the medication and control groups whose urine morphine was not negative until days 9 and 11 respectively.

1 Ng, Beng-Yeong. Qigong-induced mental disorders: a review. Australian and New Zealand Journal of Psychiatry 1999; 33(2):1440-1454.

2 Lake J. “Qigong” Complementary and Alternative Medicine in Psychiatry, Academic Press. 2001.

3 Johnson JA, Howell MH, ed.  Chinese Medical Qigong Therapy: A comprehensive Clinical Text. May, 2002. The International Institute of Medical Qigong, Pacific Grove, California USA

4 Holland A. “Voices of Qi - An Introductory Guide to Traditional Chinese Medicine” North Atlantic Books, 1997.

5 Tang KC.  Qigong therapy-it's effectiveness and regulation.  Am J of Chinese Med, April, 1994;22(3-4):235-42.

6 Sancier K, Holman D.  Commentary: Multifaceted health benefits of qigong.  The J of Alternative and Complementary Medicine, 2004;10(1):163-165.

7 Tang C, Wei X. “Effect of qigong on personality,” 2nd World Conf for Acad Exchg of Medical Qigong, 1993

8 Wang J. “Role of Qigong on Mental Health,” 2nd World Conf for Acad Exch Medical Qigong, 1993.

9 Schwartzman L. “Tai Chi and Parkinson's Disease,” 2nd World Congress Qigong, 1998.

10 Li et al, “A Comparative Study of Qigong and Biofeedback Therapy,” 2nd International Conference on Qigong, 1988.

11 Kato T, et al (rec.9220, no title given) “Japanese Mind-Body Science” 1, pp29-38, 1992.

12 Hutton D, et al. “Alternative Relaxation Training for Combat P.T.S.D. Veterans,” 3rd World Conf. Acad Exch Medical Qigong, 1996.

13 Cousins C “Research Findings of the Qigong for Children Project, The American Foundation of Traditional Chinese Medicine,” 1999 (unpublished).

14 Li M, et al. “Qigong Treatment for Drug Addiction,” 3rd World Congress on Qigong, 1999.