Essentials of Complementary and Alternative Medicine (June 1999)

Pathogenesis and Etiology
According to TCM theory, the causes of illness are generally attributed to both external and internal factors. External climatic factors, such as wind, cold, heat, 
moisture (dampness), dryness, and heat (fire), are able to cause imbalances in the energy and meridian systems and thereby interrupt normal physiological functions, 
which results in ailments. Furthermore, it is hypothesized that wind, heat (fire), moisture (dampness), dryness, and coldness can affect the energy and function of the 
liver, heart, spleen, lung, and kidney, respectively. When these organs are affected, the color of the skin, face, and tongue may turn yellow, red, green, white, and 
gray, which indicates the corresponding malfunction of liver, heart, spleen, lung, and kidney. Injuries, poison, parasites, and plagues are also recognized as external 
etiological factors.
Two groups of internal factors can affect the energy balance. The first group relates to emotional imbalance, which is also recognized by psychosomatic medicine as 
an important factor in affecting health. Acute emotional outbursts and chronic states of anger, joy, worry, sadness, and fear may affect the meridian system and disturb 
the function of the liver, heart, spleen, lung, and kidney, respectively. The second group relates to an abnormal lifestyle, such as excessive eating and drinking, 
overwork or exhaustion, and a sedentary style of living (boredom, inactivity, and sometimes depression).

Chi imbalances caused by external and internal factors may affect the body on three levels:
1. Superficial level (skin, hair, and muscle).
2. Meridian level.
3. The internal organs deep inside the body.
For example, with chronic exposure to wind, a person may first develop superficially sensitive skin and muscle, then subsequent diseases of the internal organs, such 
as liver and kidney dysfunction. Chronic elevated anger state (e.g., Type A personality) may result in changing of facial color from normal to red; disturbances of the 
heart meridian; and illness associated with the heart meridian, such as hypertension and heart disease.
Diagnosis
One of the unique features of qigong healing is that the qigong health provider can use his or her trained and expanded awareness directly to detect energy 
imbalance. Energy disturbances can be diagnosed with the hand, qigong meridian examination method, visual or mental inspection, or a combination of these 
methods. Most qigong healers tend to use the first two methods for diagnostic purposes. To perform hand diagnosis, the diagnostician brings his or her hand close to 
the patient's body and scans the patient's energy field. A normal variation of energy distribution, activity level, and other energy characteristics in healthy individuals 
may be noticed.
With this information, the diagnostician proceeds to pinpoint the manifestation of energy disturbances on the meridian and organ systems with the qigong meridian 
acupressure method and other physical examination techniques. Complementary to this direct detection of energy disturbances are the well-developed TCM 
diagnostic methods, which rely on ordinary human behavior sensation, perception, and cognition to diagnose and infer energy disturbances. Visual inspection, 
questioning, listening (smelling), and palpation are used to collect physical and behavioral signs of discomforts and abnormalities. The diagnostic results are 
categorized into four dialectic patterns, which are comprised of eight bipolar factors (
Table 23.1
). These four patterns are yin/yang, fullness/emptiness, hot/cold, and 
interior/exterior. Metaphorically speaking, at the physiological level,  yin/yang is analogous to the parasympathetic/sympathetic dyad. At the neural level, this pattern is 
analogous to the inhibition/excitation relationship. Fullness/emptiness represents excess or deficient energy. Cold/hot represents the thermal properties of the various 
human physiques. Interior/exterior demonstrates the peripheral, or core, components of the human body. Under normal circumstances, the energy system maintains a 
harmonious yin/yang, fullness/emptiness, and hot/cold relationship inside and outside the body. However, external and internal factors may derail this intricate 
harmony, thus affecting first the exterior part of the body and later the interior organ systems.
Table 23.1. Patterns of Illness
Therapy
Based on the results of chi, energy, and TCM diagnoses, the healer is ready to suggest appropriate treatment methods. The patterns of disturbed energy and the 
principles and methods of treatment are shown in 
Table 23.2
.
Table 23.2. Energy Disturbances and Methods of Qigong Treatment
Specifically, qigong meridian massage (QMM) can be used to replenish the deficient energy in a particular meridian; the healer can apply pressure on the affected 
area along the direction of energy flow. To deplete excessive energy, pressure can be applied on the affected area  against the direction of the energy flow. To 
facilitate energy flow in a blocked area, the healer can press, massage, or knead the area. To disperse energy concentrated in certain areas, a rotating movement can 
be used, starting from the center of the affected area and working toward the peripheral region. The healer can also use this rotating motion to move energy into a 
deficient area by starting from a peripheral area and working toward the center of the targeted area.
The same treatment principles used for QMM also apply to the extrinsic- chi treatment method, with the exception that the healer performs the healing at a distance. 
After self-preparation, the healer then uses his or her finger, fingers, or palm to project energy toward the patient's energy field. Once the healer feels the connection 
between his or her energy and the patient's, the patient's energy can be guided to flow in the natural direction to replenish energy deficiency, or against the natural 
direction to release blocked or stagnated energy. The healer can also infuse his or her own energy into the patient's energy system or drain excessive energy out of 
the patient's system by intention (i.e., volition with a sense of direction, and with clear formulation and deliberateness).
The application of intrinsic  chi to heal also adheres to the aforementioned principles. With the healer's finger placed on an acupoint or with his or her palm on a 
particular location, intrinsic  chi is infused into the patient's body. This intrinsic  chi method is frequently combined with QMM to correct the condition of  chi deficiency. 
The patient may also be prescribed SHQ as a primary healing modality (
Table 23.3
).

Table 23.3. Types of Self-Healing Qigong (SHQ)
PROVIDER–PATIENT INTERACTION
The qigong health provider can assume the role of healer, teacher, or both. As a healer, he or she serves the client in a role similar to that of the health provider in 
conventional medicine. This novel way of understanding the etiology of diseases should be explained to the client, and the patient should be taught to lead a new way 
of life—to live in harmony with oneself, others, the immediate environment, and the universe. In this sense, the qigong health provider should also serve as a model of 
sound living.
Patient-Assessment Procedures
H
ISTORY
-T
AKING
A detailed record of the patient's history is established. Dates of visits, general patient information, and source of referral are recorded in the patient's chart. The 
provider then continues to establish the patient's history by interviewing the patient in an empathic and friendly atmosphere concerning his or her major complaints 
and relevant minor complaints. The record of the presenting health problem includes descriptions of the onset of the problem, the circumstances in which it 
developed, its manifestation(s), and treatment history. The symptoms are described in terms of location, nature, quantity and severity, timing of occurrence, factors 
that have aggravated or relieved them, and associated complaints.
A comprehensive health history of the patient is taken as well. Childhood illnesses, accidents, injuries, or falls are most relevant. Patients are asked to describe in 
detail how accidents and injuries have occurred; these early experiences may damage their meridians and result in latent manifestation of health problems. 
History-taking is also the right time to gather the patient's family health history for future reference. The patient's current health status and psychosocial history are 
recorded as well.
C
HI AND THE
 P
HYSICAL
 E
XAMINATION
The body weight, body height, and other pertinent information, such as blood pressure and laboratory test results, are recorded in the patient's chart before  chi and 
physical examination. For a complete checkup of the energy system, the patient should lay on his or her back with palms facing up. The healer starts the examination 
from the top of the patient's head. By bringing his or her hand close to the patient's head, the healer may sense the patient's energy field. Thereafter, the healer's 
hand moves down to check the energy condition of the eyes, nose, ears, neck, chest, stomach, bladder, and extremities. This process is repeated as needed. Once 
this phase of the examination is complete, the healer examines the patient's general energy condition while the patient is lying down on his or her stomach. Aside from 
the general condition of the energy system, the healer notes the energy condition of the meridian systems.
During this phase of examination, the healer notes the nature of the energy conditions. Is the energy active, piercing, even, hot, wet, or dry? Can the energy be 
detected at a distance or at close range? When the energy checkup is complete, the healer should have a good idea of the patient's energy conditions. After 
completing the energy examination, the healer then proceeds to perform a physical examination to investigate the impact and severity of the energy disturbances on 
exterior and/or interior parts of the body as well as on the meridian system. The healer should first pay attention to any injuries, open sores, tender and stiff areas, and 
any discomforts, and then conduct a general physical examination. This should be done by applying TCM diagnostic methods as described in 
Chapter 12
, “Traditional 
Chinese Medicine.” If the healer feels that laboratory and other tests are required, he or she should ask the patient to consult with the primary care physician.
At the end of the general examination, the healer should proceed to narrow the examination down to the location of energy disturbances or to the location with which 
the patient has complaints. For example, if the patient complains of headaches and the healer finds energy imbalances in this area, the healer should determine the 
nature of the energy disturbances. To pinpoint meridian problems, finger or fingernail pressure can be applied to various locations in the head region. If the patient 
shows aversive reactions or avoidance behavior to pressure on acupoints of the gallbladder, bladder, or governing meridians, the healer needs to examine the whole 
meridian system to determine other problem areas within that system.
Differential Diagnosis
D
ISEASE
 C
LASSIFICATION
Most patients in the West who visit alternative medicine clinics come with a well-diagnosed illness made by conventional medicine physicians. This provides an 
excellent opportunity for a dialectic synthesis of mainstream and alternative medicine. The qigong healer can take advantages of both systems to prescribe a better 
course of treatment. However, the physician should be aware of the cultural differences in devising a disease classification system (
16
, 
17
 and 
18
).
TCM attributes pathogenesis and etiology of illness to the derailment of the energy system's homeostatic state; thus, practitioners of this modality have developed a 
system of disease classification different from that of the symptom-driven (disease-oriented) system of conventional medicine. According to TCM, pathology is the end 
product of this derailed energy system. Therefore, the first order of business in TCM is to correct the energy condition rather than to remedy pathology. With this 
theoretic orientation, TCM has developed a scheme to classify symptoms into patterns of illness according to the eight principles of four dialectic opposites ( yin/yang, 
cold/hot, fullness/emptiness, and interior/exterior). 
Table 23.1
 presents a representative sample of symptoms that correspond to the patterns of illness.
Each one of the patterns represents a deviation from the individual's harmonious energy state. For example, the pattern of emptiness shows a lack of energy, weak 
body and voice, loss of appetite, and weak pulse. To heal this patient, the practitioner must strengthen the energy system. The illness seen in a fullness pattern 
indicates that the patient has excessive energy buildup and is also possibly invaded by sick  chi. This patient is physically strong, speaks with a loud voice, and has 
breathing that is heavy and loud. Other symptoms of this pattern are dislike of the cold, constipation, difficult urination, very strong pulse, and a tongue that is red and 
tight. The healer should release the patient of the sick  chi and allow the normal energy to carry out the physiologic functions.
By the same token, the cold pattern should be treated with warming methods, such as infusing  yang energy to the patient, performing qigong exercises to enhance 
energy, or prescribing warm herbal soup. The hot (fire or fever) pattern should be treated with modalities that cool and neutralize this pattern.
These principles have also been used to more specifically classify disturbances at the level of energy fields, meridians, and internal organs. Chi disturbances are 
described in terms of these principles as well as other characteristics (
Table 23.2
). The afflicted meridian systems are categorized as suffering from  yin or yang, 
excess or deficiency, and cold or hot, and their associated symptoms are manifested in the interior or exterior body parts. If the energy disturbance continues, it can 
cause organ dysfunction; such disorders can then be categorized accordingly. Thus, liver disorders may be attributed to deficient or stagnated liver energy (or liver 
fire), and respiratory problems may be caused by deficient lung energy; invasion of cold, wind, or fire to the lung system; or ingestion of excessive  yin vegetables and 
cold drinks. (The term fire is used here symbolically. Its metaphoric meaning includes extraordinary energy of heat and/or fever, without any connotation of 
inflammation.)

THERAPY AND OUTCOMES
Treatment Patterns
Drawing from the unique features of ailments that are intimately related to the general conditions of the energy system, as indicated in 
Table 23.1
, qigong healers 
generally adhere to the eight previously described principles to prescribe treatment plans:  yin/yang, hot/cold, fullness/emptiness, and exterior/interior patterns.
Treatment Options
Patients who are looking for qigong treatments have two options. The first option is to visit a qigong clinic that uses the traditional healer–client approach. The 
practitioner serves primarily as a healer, and he or she may also assume the role of teacher to instruct self-healing techniques. The second patient option is to look 
for classes or groups that offer instruction on SHQ.
Description of Treatments/Interventions with Case Examples
The healer should treat the general conditions of the patient before attending to specific problems. For example, if the patient's energy is scattered and unstable (e.g., 
in the case of severe anxiety), the healer needs to consolidate the patient's energy before other health problems are treated. The healer should ask the patient to sit 
straight on a chair with neck, shoulders, and lower back relaxed, chin slightly pulled in, and a smile on his or her face. This posture allows for the natural flow of 
energy.
The healer then asks the patient to place his or her hands on the navel area with closed eyes, which allows the energy to return to the  chi (Dantian) reservoir that is 
located near the navel area. Then, the healer places his or her hand near the navel area of the patient for approximately 1 minute and uses the power of the mind to 
consolidate the patient's energy. The healer may have to repeat this consolidation technique several times to achieve the desired effects. In a case of severe anxiety, 
the healer should also encourage the patient to practice sitting meditation at home in the same posture at least once a day until the next visit. The guiding principle for 
meditation is that it should be practiced in a relaxed manner. When the mind is not calm, the patient should stop meditating, but the patient should return to meditation 
when the mind is more relaxed. Otherwise, the patient may be so frustrated that he or she will stop the exercise altogether.
One of the frequently encountered energy problems is the uneven distribution of energy around the body. This may lead to the manifestation of physical illness on one 
side of the body and a general feeling of off-centeredness in mental and behavioral responses. For example, some patients tend to have health problems on the right 
side of the body, such as headaches, back pains, and skin problems. When this type of patient is asked to sit in a quiet and relaxed manner, his or her body tends to 
tilt to one side. In this case, the healer should correct this energy imbalance before treatment of any related health problems begins. To balance the patient's energy, 
the healer places his or her hand near the base of the patient's spine and moves up slowly towards the head and over it, and then moves the hand to the front of the 
body. At any given time, when the healer detects uneven distribution of an energy field, he or she moves the hand several times around that region to make sure that 
the distribution of that energy field is rectified. Once this is accomplished, the healer can proceed to treat specific problems in the local areas. The following two cases 
describe treatment methods.
C
ASE
 E
XAMPLES
CASE 1: HYPERTENSION
A 40-year-old man who is studying for a college degree presents with a 2-year history of essential hypertension. He notes that medications for his hypertension are 
near the maximum dosage level and that he dislikes their cognitive side effects. After taking the medication, he cannot concentrate on his studies. He wants to find 
an alternative treatment so that he can finish his degree. Laboratory tests, including a computerized axial tomography scan and renal studies, do not reveal any 
pathological conditions.
Chi examination indicates that this patient has excessive energy in the head and chest regions. The physical examination does not reveal any significant clinical 
problems. However, the practitioner notices that his face and eyes are very red, and his tongue is cherry-red. His pulse is very strong and fast. He likes cold 
beverages and hates hot drinks. His muscles around the neck and shoulders are extremely tight. He also suffers from occasional numbness in his thumbs as well as 
the fourth and fifth fingers. QMM examination further reveals that the patient is very sensitive to pressures around the wrist and fifth finger. He is also quite sensitive 
to pressures exerted on the lung meridian near the pectoral area, elbow, and thumb, which indicates that  chi disturbances have already invaded his meridian 
systems and affected cardiovascular function.
The healer observes that the patient is suffering from a  yang pattern of illness, with disturbances in the heart and lung meridians. In this case, the healer should first 
release the excessive energy in the head and chest area, then harmonize the  yang and correct the heart and lung meridians. The healer can use his or her hand to 
move the excessive energy in the head to the front and down to the lower part of the body, thus balancing the energy distribution. QMM should also be applied to 
balance the heart and lung meridian energy. In addition, the healer should instruct the patient on SHQ breathing exercises to release excessive energy. Treatment 
results in improved concentration even with continued use of the medications.
CASE 2: DEPRESSION
A 45-year-old woman presents complaining of depression and suicidal ideation. She is cared for by a psychiatrist but hates the side effects of her antidepressant 
medication. She rarely has a good conversation with her husband because of his busy schedule. She complains of losing her appetite, waking up at approximately 4 
AM
 without being able to fall sleep again, suffering shortness of breath, and lacking motivation to do anything. She is grossly underweight. Her face is pale, her 
tongue is pale with a yellowish tint, and her pulse is very weak.  Chi examination reveals that she has a very weak energy field, although the energy is quite evenly 
distributed around her body. This is a severe case of emptiness pattern. The color of the tongue and shortness of breath may suggest minor problems in the liver 
and lung meridians. QMM examination of the acupoints along these two meridians indicates that the upper chest area is very sensitive to pressures, which suggests 
an accumulation of stagnant energy in the lung meridian area.
To treat the patient, the healer uses external  chi for approximately 1 minute to replenish the patient's energy. Afterward, the patient is given QMM to clear the 
blockage in the lung meridian to facilitate energy flow. The patient is then taught movement qigong to practice at home for approximately 20 to 30 minutes a day. 
These qigong exercises should ideally be done in the morning to harness the morning  yang energy. Breathing exercises to rectify energy conditions should also be 
taught and practiced. Continued treatment and regular practice result in improved mood and sleep, as well as less bothersome side effects from medication.
Treatment Evaluation
E
XPECTED
 C
HANGES IN THE
 P
ATIENT
Effective qigong treatment results in restoration of the energy field back to a healthy state, correction of meridian functions, improvement and elimination of complaints 
and signs of discomfort, and amelioration of illness.
How the Magnitude of Change Is Assessed
The healer relies primarily on  chi and TCM examination methods to monitor changes in the patient. Simple measures may also be used to monitor physiological 
changes, such as blood pressure, heart rate, muscle tension, and peripheral and core temperature. Whenever it is necessary, the patient should be followed by 
conventional physicians for laboratory and diagnostic tests to validate and monitor significant changes in the pathological conditions. The frequency and severity of 
complaints represent major variables in determining continuation of treatment. Unfortunately, subjective reports may not be sufficient grounds for treatment 
termination because ordinary human sensation and perception may not be sensitive to the subtlety of the disease-causing energy disturbances. However, failure of 

objective signs to improve may mean that aspect of the disease is refractory to qigong treatment and requires other interventions.
Time Period in Which Changes Occur
Changes in the overall energy field may occur in a relatively short period of time. The exterior expression of the illness, such as the color of the skin, face, and tongue, 
is also very responsive to changes. Red and pale facial color may change to normal pink color during the first treatment session, largely caused by changes in 
microcirculatory functions (
19
, 
20
 and 
21
). Yellow and gray will take longer because of the severity of  chi disturbances. Physical signs and discomfort related to 
exterior components of the body may take on average four weekly treatments to show significant changes. The affected meridian systems may require approximately 
eight treatments to regain normal function. When  chi disturbances invade the interior components of the human body and result in diseases of internal organs, the 
observable improvements may not take place until after 3 months of treatment. For chronic illness, such as arthritis, liver disorders, and cancer, significant changes 
may not occur until one half a year to a year after beginning the treatment. External healing techniques used by qigong healers generally tend to produce changes 
faster than SHQ techniques alone.