Essentials of Complementary and Alternative Medicine (June 1999)

USE OF THE SYSTEM FOR TREATMENT
Qigong is one approach within Traditional Chinese Medicine and is therefore usually delivered in the context of TCM, which includes dietary changes, acupuncture, 
herbal medicine, and manipulation. However, the use of both external and internal qigong produces effects on its own and may be the treatment of choice for certain 
conditions. From the Western perspective, qigong looks like a combination of relaxation, breathing, and exercise, and so it would be expected to help conditions that 
these behaviors are known to benefit: respiratory disorders, neuromuscular problems, psychological problems like depression, and certain physiological conditions 
such as hypertension and fatigue. From the perspective of TCM, however, qigong provides a major way to alter and balance  chi, thus making it ideal for several 
conditions in both early and late stages. Fortunately, a considerable amount of research has been conducted on qigong in China and elsewhere that can serve as a 
guide to its major indications (
6
, 
20
).
Major Indications Based on Approach
M
OST
 U
SEFUL AS
 A P
RIMARY
 A
PPROACH
Regular qigong practice increases respiratory volume and improves oxygen uptake and carbon dioxide exchange (
19
). It is therefore not surprising that qigong is an 
effective treatment of asthma and emphysema (
21
). Increased microcirculation (
22
, 
23
) and reduced reactive catecholamine production and sensitivity (
24
) seem to 
occur with prolonged qigong practice, with effects on cardiovascular disease including increased cardiac output (
24
), reduced heart rate (
25
), and ischemia (
22
, 
23
). 
Enhanced lipolysis (
26
, 
27
), improved lipoprotein levels (
28
), reduced hypertension (
29
), and increased aerobic conditioning (
25
, 
30
) may also contribute to the 
prevention of or improvement in cardiovascular disease.
Qigong has been shown to produce significant improvements in neurological and psychological function. These include improvements in memory (
31
) and learning 
capacity (
32
), reductions in anxiety, fatigue (
30
), and hyperactivity (
33
), improvements in nerve function (
34
), and changes in EEG patterns (
5
), typical of some types 
of meditation.
Slowed or reversed effects of aging have also been reported in several studies, including increases in bone density (
33
, 
35
) and estradiol levels in aging women (
36
), 
and improved respiratory, cardiovascular function, balance, and other age-related effects in normal elderly (
5
). Some studies have also suggested increased 
resistance to infection (
37
, 
38
). Finally, reduced side effects from chemotherapy and radiation during cancer treatment have also been reported with qigong use (
39
). 
While many of these effects are well documented, others are based on preliminary research or are done in China where the quality of clinical research is inconsistent. 
These findings are consistent, however, with demonstrated effects from studies done in the West from exercise, breathing, and relaxation techniques when applied 
intensively.
C
ONTRAINDICATIONS AND
 A
DVERSE
 E
FFECTS
Chinese qigong practitioners warn that inappropriately applied qigong therapy can be harmful. A so-called adjustment or adaptation phenomenon is commonly 
reported in which a number of unpleasant symptoms, such as muscle aches, pain, fatigue, and other symptoms, can occur from qigong (
1
, 
22
, 
40
). These symptoms 
are usually minor and temporary but do need to be managed properly. Qigong exercises, if applied vigorously and consistently, need to be adapted and individualized 
to the patient's needs and conditions. For example, some types of qigong exercises (such as those similar to tai  chi or practices that focus on forehead concentration) 
may increase sympathetic tone and be contraindicated for those with anxiety, hypertension, and angina (
38
).
The Chinese Classification of Mental Disorders-2 describes a qigong deviation syndrome (QDS) characterized by specific abnormal  chi movement and manifesting in 
symptoms such as malaise, headache, insomnia, abdominal distension, and other symptoms. Xu (
41
) has pointed out that some schools of qigong emphasize 
producing rapid changes by using suggestion and autosuggestion techniques. These approaches can increase the risk of anxiety, depression, hallucinations, and 
psychological disturbances similar to inappropriate application of hypnosis. The appropriate application of qigong in any serious manner requires detailed 
understanding of the patient's condition, predispositions, and skill and training on the part of the practitioner. Unfortunately, few qigong practitioners in the West have 
this training or work in an environment that can assure the safe and skilled application of qigong as a therapy for serious diseases. The physician is in a unique 
position to provide such an environment by assuring that minimum requirements for application of qigong therapy are arranged. Some of the requirements for such 
application are discussed below.
ORGANIZATION
The qigong perspective presented in this chapter is a dialectic synthesis of both TCM and conventional medicine. As such, the basic training involved in both TCM 
and conventional medicine is necessary, but not sufficient, training for a postconventional qigong healer. To that end, some specific prerequisites, requirements, and 
curriculum components should also be taken into account.
Training
P
REREQUISITES AND
 R
EQUIREMENTS
Qigong is not simply a therapeutic technique, but a healing art. It requires talent and temperament as well as training. Talent includes sensitivity or receptivity to  chi 
and the ability to comprehend the rationale underlying qigong practice. Like hypnotizability and many other abilities, sensitivity and receptivity to  chi may be inherently 
different for each individual. To be sure, this skill is not an all-or-none nonverbal intelligence, but a characteristic that differs in degrees among individuals. Students 
with higher sensitivity to chi have greater potential to become more competent healers. Along the same line, the ability to understand the subtlety involved in qigong is 
also necessary for becoming a true healing artist. Performing qigong without a deep grasp of its theoretical foundation would mean that the qigong movements would 
be ungrounded gestures lacking significance.
Temperament refers to empathy and humanistic and humanitarian devotion. As a transcendental philosophy of life, Taoism, the philosophical foundation underlying 
qigong, helps people reflect upon the purpose of our existence, for which human connection and compassion play a very important role. Enlightened by this teaching, 
qigong healers view their profession as a calling to help human beings become integrated with nature (namely, heaven and earth, metaphorically speaking) by means 
of chi—to return to integrity and balance and to make whole the  sine qua non of healing (
42
). Qigong as a healing art aims for the integration of body, mind, and spirit. 
To serve this purpose, qigong healers themselves must have integrity of sound body, mind, and spirit. The sound spirit presupposes the temperamental factor already 
mentioned.
C
URRICULUM
 C
OMPONENTS
Given qigong as a culture-embedded medicine, a general understanding of the traditional Chinese cultural context, especially the world view, seems necessary. This 
learning is better achieved in a course like medical anthropology because the anthropological point of view is nonjudgmental and intersubjective (
43
, 
44
) and thus 
helpful for students to assimilate the new knowledge and to accommodate this knowledge with their original world view. A well-designed course of medical 

anthropology in this regard should put the “old wine in a new bottle”; that is, examine and reconstruct the classical contents of Chinese cultural context from a 
posttraditional perspective.
For further development of the qigong curriculum, what has been presented so far in this chapter may provide a rough guideline. In addition, some components of the 
qigong training program include the following:
1. Introduction of the traditional point of view, which distinguishes tradition from traditionalism (this is essential).
2. Integration from a dialectic synthesis of TCM and modern science.
3. Relaxation theory and practice.
4. Significance of regulating the body.
5. Basic posture of regulating the body (rooting, centering, and balancing).
6. Choice of positions in qigong exercise.
7. Introduction to the action of consciousness, implicit consciousness, and mindful/mindless qigong.
8. Tactics of generating conscious awareness, holding attention within, and stopping of thoughts.
9. Strategies for developing inner serenity and control over involuntary functions.
10. How to solicit transcendent intuition and understand it.
11. How to best use this symbolism by relating to Jungian theory.
12. Different approaches to qigong respiration.
13. General keys to regulating normal respiration.
14. Duration and other training requirements.
At present, Zou Du University in the Hai Ding District in Beijing offers a two-year training course for potential practitioners, and Tianjin University in Hebei province 
also offers four quarterly medical qigong classes yearly. Short-term workshops and seminars have also been provided by TCM colleges, such as the Qigong Institute 
of the TCM Academy of Shanghai, and universities, such as the Beijing Institute of Technology and Beijing University of Agriculture and Engineering in China. Both 
the duration of training and the training requirements vary according to the goals and backgrounds of the students. Given that qigong is a form of TCM, Western 
students may need a longer duration of training and more training requirements to reach the same goals. The curriculum components listed previously are geared for 
trainees of qigong healers.
Quality Assurance
Until recently, few well-designed studies of medical qigong's efficacy have been recognized by mainstream researchers. To demonstrate medical qigong's efficacy by 
ruling out the placebo effect and other alternative explanations, a double-blind and well-controlled design is necessary according to the standards of conventional 
medicine. Admittedly, this evaluative process is not sufficient because the conventional approach is generally reductionistic, mechanistic, and outcome-oriented. As 
such, it is less likely to evaluate a whole picture of the vital organism as well as the therapeutic process involved. To that end,  Geisteswissenschaften—the German 
term for holistic human studies—should be applied to explore the therapeutic phenomena observed in the medical qigong process.  Geisteswissenschaften includes 
phenomenology, hermeneutics, and so forth and is especially useful for carrying out studies that are embedded in the Chinese cultural context (
2
, 
45
, 
46
). 
Unfortunately, few researchers use this approach to conduct the study of qigong.
Moreover, longitudinal follow-up of qigong healing is also required to confirm the long-term effect. Otherwise, qigong therapy may just work like a drain opener, which 
can only open the clogged drain for a while but cannot keep the water flowing forever. As far as we know, most longitudinal follow-up studies of qigong and other TCM 
modalities have continued for only 6 months. Because the efficacy of qigong healing remains to be confirmed and the operational mechanism of qigong needs to be 
demonstrated, quality assurance is difficult and often filled with controversy. Still, for the sake of the patients' physical, psychological, and financial concerns, such 
measures should be attempted.
L
ICENSURE AND
 C
ERTIFICATION
In the past two decades, there has been a rapid rise in the popularity of medical qigong as a form of therapy in China, where the official position has been “not to 
publicize and not to deny.” This position means they accept but do not advocate it. On November 19, 1989, the Chinese Ministry of Public Health introduced on a trial 
basis 14 regulations regarding medical qigong, and the Central Traditional Chinese Medicine Bureau tightened its control over qigong masters (
47
). Some of these 
regulations may be adapted to other countries, as shown in the following list:
1. If a person provides treatment by emitting chi, he or she has to apply to the medicine section or the medical administration for approval to practice. If the 
treatment of 30 cases of the same kind is statistically confirmed as effective by the authorities, a certificate will then be issued to the applicant to provide such 
specific type of treatment.
2. The treatment effect must be demonstrated longitudinally as well. Moreover, not only should the treatment outcome be examined, but the processes of learning 
and providing service need to be monitored as well. The best way to do this is to require students to be interns or apprentices in a qigong hospital and clinic for 
a certain period of time before taking the license examination. During their internship they can build up the 30 clinical cases under supervision for their 
examination, and their case reports can be used by their affiliated hospital or clinic as partial fulfillment for the evaluation of that institution.
Unfortunately, not even such minimum requirements are present in the West.
L
EGAL
 S
TATUS AND
 R
EGULATION
Medical and public health authorities can employ qigong masters who have been qualified under the aforementioned regulations to perform qigong therapy. Should 
qigong be used to treat disease, a full medical record must be kept to evaluate its long-term effectiveness.
Medical qigong activities must be documented reliably without selection bias. Misleading readers of advertisements by relating superstition with therapy is deemed a 
violation of professional ethics. All advertisements and promotion materials about medical qigong should be approved by medical and public health authorities.
Anyone found to have contravened these regulations is warned, fined, and suspended or banned from practice. These actions are enforced by the medical and public 
health authorities in conjunction with appropriate medical associations. All healers who have been in medical qigong practice before the introduction of these 
regulations must apply for approval of such practices.
Unfortunately, no such regulation of qigong practice occurs in the West except to prevent qigong practitioners from practicing medicine without a license. Thus, 
anyone can hold themselves out as a qigong “master” without proof of training or competence. Patients and physicians should ask for documentation of training and 
certification.
P
ROFESSIONAL
 S
OCIETIES AND
 C
ONTINUING
 E
DUCATION
The China Research Society of Qigong Science is the major professional qigong association in China. Professional societies at local levels are numerous, and a 
quarterly journal, China Qigong, is published at Bei Dai He Qigong Hospital. As of 1990, the circulation of each issue was approximately 80,000. In general, the 
associations or societies have sanction power, provide peer-review and referral services, and organize conferences for scholarly exchange and workshops or 
seminars for continuing education. Any workshop or seminar has to be preapproved by the academic committee of the professional association, and official credits 
are issued to the participants.
Reimbursement Status
In China, fees charged for qigong treatment are supposed to be reasonable and worked out jointly by the authorities and the local consumer council. Exorbitant 
charges are prohibited. As discussed earlier, qigong healers claim to call on cosmic and divine power, which resides at a higher level than the secular level, to help 
human beings. The aim of qigong healers is to help people relate to the  intention, or mind, part of the body-mind-spirit tripartite system because the mind plays the 
most important role in qigong practice (
48
). The mind provides the direction for the flow of the  chi, and purer intentionality induces better direction. Empirical research 

(
49
) has also revealed that theta waves were lower and beta waves were higher during qigong practice that incorporated concentrative mind focus versus qigong 
practice that employed nonconcentrative mind focus. During concentrative mind focus, any ideas other than helping the patient would distract the healer's mind and 
misguide the chi flow. However, the survival of qigong therapy as a profession is certainly dependent on financial support. Fees for service should be based 
realistically to maintain the positive interaction between qigong therapists and their clients. Concerning reimbursement status of qigong therapy, it could be 
commensurate with that of physical therapy.
No reimbursement for qigong generally occurs in the West except as part of other treatments. In those cases, it is usually treated as part of physical therapy.
Relation with Conventional Medicine
As purported earlier, TCM–based qigong therapy and conventional medicine can be integrated in a dialectic synthesis. Conventional medicine is viewed as a thesis 
built on reductionism originating from Auguste Comte, mind/body dualism initiated by Reneé Descartes, the concept of mechanic physics constructed by Issac 
Newton, and analytic philosophy and logical positivism. In contrast, being rooted in TCM, qigong therapy is holistic in nature. In that sense, after it differentiates 
complex phenomena into separate and simpler parts for analysis, it weaves them together as a whole web. The thread that connects every part is  chi, which manifests 
itself in different forms within each segment of the mind-body-spirit tripartite system. In so doing, it is able to see not only each single tree in the forest, but also a 
bird's-eye view of the whole forest.
In addition, qigong is better understood by quantum physics than the Newtonian mechanical concepts that explain conventional medicine. This is because quantum 
physics recognizes aspects of reality beyond Newtonian mechanics and consequently helps to illuminate some of the mechanisms underlying qigong. In a similar 
vein, the methodology commonly employed in mainstream medical research is insufficient for the exploration of qigong therapy. The fact that conventional research 
methodology has difficulty assessing the observations seen in qigong therapy and practice is often used as a justification for refuting qigong.
PROSPECTS FOR THE FUTURE
Qigong has a long, time-tested track record as a therapeutic tool that has prevailed among a billion people in China. Its long-lasting prevalence cannot be attributed 
completely to its medical value because economic, cultural, and other contextual factors also play an important role. As such, distinguishing the medical  sine qua non 
of qigong from other contributing factors seems to be indispensable for its application to other sociocultural contexts. For that purpose, a scientific approach to the 
study of qigong is needed in modern global world culture.
The scientific approach suggested previously integrates both natural and social scientific methodology. The inclusion of natural sciences into the research design 
here obviously requires no justification, whereas the main reason for taking social sciences into account is to comprehend the cultural, social, psychological, and 
spiritual factors involved in qigong treatment. Given qigong as a synergistic system of body, mind, and soul, these factors have been much less attended to compared 
with the scientific aspects of this modality, so they need to be affirmed in the future. The few available empiric studies addressing the issues related to the mind-body 
connection can be seen in the work of Omura and Beckman (
37
), Sancier and Hu (
50
), and Tsai et al. (
22
). Among these studies, the work of Tsai et al., in which the 
psychological variable—ability to function—was observed and measured, can serve as a model for further research along this line. Specifically, Tsai et al. evaluated 
the qigong program's efficacy according to patients' subjective improvements, which were graded according to the Karnofsky scale. Patients' subjective feelings were 
recorded faithfully, thereby indicating the patients' sense of well-being.
As pointed out previously, the identification of the operational mechanisms underlying qigong treatment is important for assuring the consistency of this modality's 
quality as well as for demystification purposes. To that end, both process-oriented and outcome-oriented research design should be taken into account. So far, most 
studies have been outcome-oriented, so researchers have not been able to monitor how the potential mechanisms work. Instead, the researchers can merely infer the 
mechanisms indirectly from the final results. To design process-oriented research, idiographic methodology is more appropriate than is nomothetic methodology. The 
former requires each subject to be observed intensively across different occasions of the temporal dimension and extensively across various situations on the spatial 
dimension. In contrast, the latter methodology collects data only at one point of time, but uses large sample and quantitative analyses so that general rules can be 
drawn. A complete research design needs both methodologies, as demonstrated by Lee and Lei (
40
). Without the idiographic methodology , the subject remains in the 
black box; and without the nomothetic methodology, the research result cannot be generalized to other populations. To fully understand qigong, multiple research 
methods across the full domains of knowledge, as described in 
Chapter 4
, are needed.
Process-oriented study and idiographic design also help to verify the principal concepts of the qigong system that have been presented earlier, especially the stage 
model of disease development shown in 
Figure 23.1
. Many of those concepts are either metaphysical or metaphoric (e.g.,  yin/yang) and thus short of empiric 
substantiation. To substantiate these theoretic concepts, careful observations of the disease development at every step along the way are indispensable. After TCM 
theory is empirically verified, it can be synthesized dialectically with conventional medicine, and both should be included hierarchically into postconventional medicine.
Integrated postconventional medicine is based both on quantum physics that goes over and beyond the metaphysics of TCM and on Western medicine's materialistic 
world view. To carry on both postconventional medicine's theoretic reconstruction work and empiric studies to verify dialectically synthesized postconventional 
medicine is a mission for contemporary medical students and scientists.
Author's Note: The authors wish to acknowledge the collegial support of Profs. Ellen D. Ciporen, Ronald Doviak, Sadie Chavis Bragg, and An- tonio Perez, without 
which the present chapter could not have been completed on time.