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Introduction to Medical Qigong -- the wonder and mysteries of Chinese medicine

Introduction to Medical Qigong -- the wonder and mysteries of Chinese medicine

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  • "Qigong" has existed for a long time, but it did not become popular until the 1950s when it gained public acceptance over other traditional and more abstruse terms until recently. However, there is still much misunderstanding of Qigong due to some conceptual confusion.
  • These terms are self-explanatory and are indicative of Qigong’s origins in internalized self-care exercises and life-nurturing activities.
  • Let me give two examples of early proof of qigong meditation in Chinese history… The description on the jade pendant is very similar to the Daoist art of Internal-Elixir qigong, practiced in modern time.
  • Adjustment also implies regulating or alignment.
  • To understand the differences among various qigong, there are different ways to classify qigong: Confucian qigong – e.g. sitting and forgetting; Buddhism qigong – Zen, Min, Tiantai Daoism – Taiji, art of inner elixir, Cosmo Circulation Qigong Medical --- Six healing sounds, lowering blood pressure qigong, eye-brightening qigong, Martial-art – eight peace of brocade, E Mei 12 Stances, Shaolin Inner Boxing, Difference traditionals have different purpose of cultivation, with different technique or combination of breathing-mind-body integrations.
  • Shorten to the essence – medical qigong is qigong directed by the teacher and student toward health
  • It is important for a beginner to know what s/he want from qigong before starting or choosing the right form.
  • (2)   relaxation (completely relax without falling asleep), tranquility (quite and concentrate, ignore surroundings) and naturalness (follow the natural way both physically and emotionally, without wants and strong intentions).
  • Delete
  • Until today scientists still have problem detecting properly with all the advanced equipment…
  • shorten
  • Is Qigong meditation more effective in reducing stress than regular relaxation exercise?
  • Delete – you already said a lot of this
  • shorten
  • Distinguish here between external and internal qigong studies – easy to find control for external qigong studies.
  • If you have this slide, I would take out slide above of effects on cancer/rats.
  • What are the known mechanism of meditative therapy for stress management?
  • Drop – how many people and who are doing qigong of all these – this slide is really misleading Kevin – who are these people?
  • Nice ending slide!

Transcript

  • 1. Introduction to Qigong: Mysteries & Wonders of Chinese Medicine Kevin W Chen, Ph.D. MPH Center for Integrative Medicine University of Maryland School of Medicine Email: [email_address]
  • 2. OUTLINE
    • What is Qigong?
    • Major Qigong traditions
    • Medical applications of Qigong
    • Methodology challenges in research
    • Examples of Qigong research
    • How Qigong healing works (mechanism)
    • Qigong and healthcare reform
  • 3. What Is Qigong? -- the Term
    • Pronounced as “Chi Kung.”
    • Qi = vital energy, breath of life.
    • Gong = skill or achievement.
    • Qigong is a general term for various forms of traditional Chinese mind-body exercises and therapies.
    • The practice has a history of 3,000+ years
    • Had many other names in the history
  • 4. Other Names of Qigong
    • Tu-na ( 吐纳 ) - exhalation and inhalation,
    • Dao-yin ( 导引 ) - guiding and conducting exercise
    • An-qiao ( 按蹻 ) - massaging/stepping on the body
    • Xiu-lian ( 修炼 ) - cultivating and refining
    • Jing-zuo ( 静坐 ) - tranquil sitting, sit meditation
    • Yang-sheng ( 养生 ) – life nurturing
    • Cun-si ( 存思 ) - mind-visualization
    • Guan-xiang ( 观想 ) - observing-imagination
    • Xing-qi ( 行气 ) - circulating Qi
  • 5. Example Relics of Qigong
    • Left: An ancient jade pendant inscription describing special technique of qi meditation and possible reactions (around 600 BC)
    • Right: a painted pottery jar with a sculpture in human shape on a standing meditation post, and gulping Qi… (around 3000 B.C.)
  • 6. Concept of Qi in TCM
    • Traditional Chinese Medicine (TCM) posits the existence of a subtle energy ( Qi ) circulating throughout human body.
    • Good health is result of a free-flow, well-balanced qi system, while sickness or pain is the result of qi blockage or unbalanced qi.
    • All TCM therapies, herb, cupping, acupuncture, massage & Qigong, based on this perspective.
    • Same concept can be found in other cultures: Ki (Japan), Prana (India), Mana ( Polynesia), Tane (Hawaii), and Gana (South American).
  • 7. Definition of Qigong
    • “ The skill of body-mind exercises that integrate body, breath and mind adjustments into one. ”
    • Contents: 3 adjustments
    • Purpose : Integrate 3 adjustments into oneness
    • Classification of discipline: It’s body-mind exercise – both physiology and psychology
    • Category of knowledge : operational skill or technique
  • 8. Qigong and Meditation
    • All meditations could be called “Qigong” in China
    • Qigong ≠ meditation
    • (many other forms)
    • Some call qigong moving meditation
  • 9. Zen -- One of Qigong Forms
    • Zen (Chan) is one of the major Buddhist qigong traditions in China
    • Other Buddhist Qigong: Tibet Mi (Esoteric Buddhist) & Vipassana
    • Zen is the base for mindfulness meditation.
  • 10. Reiki and Qigong
    • Japanese Reiki was originated from one of medical qigong traditions – 灵气
    • Thousands of other forms of qigong existed in Chinese history….
  • 11. Major Qigong Traditions
    • Thousands of different qigong forms can be classified into 5 categories or traditions:
    • Confucian Qigong 儒
    • Buddhist Qigong 释
    • Daoist (Taoist) Qigong 道
    • Medical Qigong 医
    • Martial-Arts Qigong 武
  • 12. Buddhist Qigong 释
    • A imed at liberating the mind, emphasize cultivating virtue and enlightening wisdom.
    • Claimed 58,000 schools in history.
    • Buddhism considers body a “stinking bag” holding the honorable spirit or soul.
    • Typical Buddhist qigong has little element of healthy body; but health could be a “side-effect” of positive or purified mind.
    • Example: Zen ( 禅 ), Tibet Mi ( 藏密 ), & Tiantai ( 天台 Shmatha and Vipasyana)
  • 13. Daoism Qigong 道
    • Emphasize the preservation of physical health, then higher level of virtue/ spiritual cultivation.
    • About 3600 schools/forms in history.
    • Daoism qigong consist of Ming-gong (for physical health) and Xing-gong (for the spirit).
    • Daoism emphasizes current life and explored techniques of a long life, many Daoist qigong masters lived an extremely long life.
    • 五秘:太极、丹鼎、剑仙、符箓、玄真门。
  • 14. Meet A Daoism Qigong Master Mr. Li Qinyun (1678—1928)
    • A herbalist & a skilled qigong practitioner.
    • Picture was taken in 1927 when he was 249.
    • As reported, he joined the army at age 51;
    • Most of his wives died early so during his life he married 14 times.
    • Secret of his longevity -- Qigong…
    • -- A factual account of the 250 year old good-luck man
  • 15. Medical Qigong ( 医 )
    • Emphasize how to use vital energy (qi) to help take control of illnesses/diseases, and how to prevent them.
    • Influenced by Daoism philosophy but developed independently mostly by TCM practitioners.
    • Historically, most famous TCM doctors were also good qigong practitioners (examples).
    • Guide medical practitioners to use inner qi for diagnosing, healing and preventing diseases.
    • Concept qi & qigong techniques--foundation of TCM
  • 16. Ancient Medical Qigong Books
    • General Treatise on Etiology and Symptomology of Various Diseases ( 诸病源候论 )-- 610 A.D.
    • The oldest specialized medical text to explore etiology & pathogenesis.
    • 50 volumes cover 67 subjects and 1739 items/entries..
    • Also record 213 various ‘Daiyin movements’ (Qigong) for 110 different symptoms or diseases!
  • 17. Other Classifications
    • (Preventive) health qigong vs. (healing) medical qigong
    • Spiritual (Confucian & Buddhism), healing (medical) and martial-art qigong…
    Important Note: All Qigong are NOT the same!
  • 18. Essential Qigong Components
    • Three adjustments:
      • Adjust body posture (stand, sit or lie down)
      • Adjust breathing (e.g. deep, even, slow and abdominal breath)
      • Adjust mind status (focus on one thing or nothing)
      • Integrate three into oneness – advanced qigong state
  • 19. Keys to Qigong Practice
    • Three essential points during practice :
      • Relaxation (both physically and mentally)
      • Tranquility (focused, concentrate and quiet)
      • Naturalness (follow the natural way physically and emotionally – whatever come, let it come and let it go…)
    • 松、静、自然
  • 20. Variation in Medical Qigong
    • Although Qigong is considered as a self-training method (see definition), the emission of Qi (or external Qi therapy) has always been part of the medical qigong practice so as to help patients to regain health or qi balance.
    • Need to distinguish between internal qigong training and external Qi therapy
  • 21. Internal Qigong Practice
    • Self practice or cultivation to achieve mind-body-breathing integration.
    • Major part of Qigong therapy.
    • Involve guided imagery, breathing skills, relaxation, inward attention, body posture, mindfulness training through three adjustments.
    • Three basic forms: dynamic, static, and standing post.
  • 22. External Qi Therapy
    • EQT -- Qigong practitioner direct or emit his Qi energy, intention, or bio-info to help other regain health.
    • Practiced through use of Qi (vital energy), or Yi (intention or mind) therapy, or a combination of the two.
    • Most schools of medical Qigong teach both techniques.
  • 23. Study of External Qi
    • The physical nature of Qi remains as yet unproven, there are some intriguing reports suggesting possibility of physical, biophysical or biochemical alterations induced by EQT or “ Qi -emission.”
    • Chen (2004) “Analytic review of measuring external qi in China” -- presents a lot of studies that applied physical, chemical, biological and life detectors in verifying the existence of external qi.
    • There is a small but growing body of scientific evidence that suggests the physical existence of Qi , and the healing power of Qigong therapy
    Chen (2004), Alternative Therapies in Health and Medicine , 10(4): 38-50
  • 24. What is found in external qi?
    • Studies suggest 3 components in “external qi” healing process:
    • Matter – such as mm micro-wave, VLF electromagnetic field, photon, particle, etc.
    • Energy – Gamma ray, far-infrared,
    • Information – bi-directional effect on bacteria growth
  • 25. Qigong and Acupuncture
    • Acupuncture shares the same qi flow and meridian theory with qigong.
    • Difference: acupuncture uses external force (needles) to help qi flow and balance, while qigong uses internal force (meditation and mind) and sometimes external qi, to do so.
  • 26. A Question for Acupuncture
    • How was meridian diagram drawn in medical book 2500 years ago?
    • We still have problem detecting them properly today…
  • 27. The Answer: Qigong Practice
    • Li Shizhen ( 李时珍 ): ‘I nner scenery and channels (meridians) could be viewed only by those who reflect or observe inwardly (through meditation)’
    • A Study on the Eight Extra Meridians ( 奇经八脉考 ): “ 内景隧道,唯返观者能照察之”
    • Diagram of Inner Scenery:
  • 28. Medical Applications of Qigong
    • Practitioners credit their qigong practice with improving daily lives & health in many ways:
    • A more relaxed, harmonious state of mind / body 
    • A noticeable reduction in prior ailments and a reduction in feelings of stress
    • An increased resistance to illness through a stronger immune system
    • A heightened sensitivity to the internal organs, with a developed ability to regulate own health and vitality
  • 29. Qigong for Stress Management
    • Huge literature (many in Chinese).
    • Most reports not on stress per se, but on the stress-related symptoms or illnesses (e.g. hypertension, headache, asthma, allege, pain, heart disease….)
    • Report on the improved heart rate variability & increased brain alpha activities – hard evidence.
    • Most qigong forms apply relaxation, breathing work, inward attention, guided imagery, biofeedback, meditation & mindfulness into one exercise – which we know helps in stress management through separate applications
  • 30. Qi Meditation vs. Other Relaxation
    • He et al. (1999) applied a “stress meter” (equipment measuring body conductivity under 5 volts of DC with 128-pin sensors) to evaluate degree of relaxation by Qigong meditation vs. a non-Qigong relaxation technique
    • Applied 10 separate measures during meditation state, 73 Ss in Qi meditation, & 56 Ss in non-Qigong relaxation
    • Ss in Qi meditation able to reach deeper level of relaxation than those in regular relaxing exercise (by skin conductance and other electronic sensors).
    He et al. (1999). Frontier Perspectives . 8(1): 37-42.
  • 31. Qigong Meditation for Stress – Mind Management
    • Work on relaxing, or relieving your mind – less worry and less attachment….
    • “ No-action” means less attached to things around that stress you…
    • An attitude change
    • Tension-release through
    • slow breathing and
    • and mind-body exercise
    • Counting breaths method
  • 32. Qigong -- an Optimal Method for Stress Management
    • When breath-mind-body are integrated into “oneness”, one would breathe at the near “resonant-frequency” – optimal state of autonomic nervous system
    • TCM believes that “Qi” goes with “Yi” – when meditation with inward attention, one can gain energy, and recover much rapidly than other relaxation methods.
  • 33. Qigong for Hypertension
    • Mayer (1999) reviewed 30 studies, explored the effects of qigong for hypertension, including a 30-year longitudinal study, concluded that qigong is an effective way to control hypertension without any adverse effects.
    • Lee et al. (2007) did a systematic review of 12 RCTs -- a ll reported positive results in at least some of the relevant outcome measures.
    • The meta-analysis suggested beneficial effects in favor of qigong: WM difference -- systolic BP -12.1 mmHg, 95% CI -17.1 to -7.0; diastolic BP -8.5 mmHg, 95% CI -12.6 to -4.4. ( J hypertension . 2007; 25(8): 1525-32)
    Mayer M, 1999. Journal of Alt & Complimentary Med, 5(4): 371-382.
  • 34. More Than Stress Management
    • Stroke and mortality rates decreased with Qigong practice (30 years follow-up study)
    • Effective in treating asthma and allege
    • Cases of spontaneous remission of multiple symptoms (Chen & Turner, 2004)
    • Conclusion: "Qigong enables the body to heal itself" (Sancier, 1996)
  • 35. Qigong Therapy for Pain Relief
    • Strong scientific evidence that relaxation and breathing techniques help relieving pain….
    • Qigong is more than just relaxation and/or breathing exercise.
    • An effective alternative for pain relief – either self application or external treatment.
    • E.g. reports on complete cure of arthritis and degenerated disc disease with qigong therapy.
    • Lee et al. (2007) reviewed 5 RCTs. The results not conclusive but very encouraging...
    Lee et al. Journal of Pain . 2007; 8(11):827-31
  • 36. Qigong Therapy for Arthritis
    • Chen and Liu (2004) reviewed 20+ studies of qigong in treatment of various arthritis, including OA, RA, scapulohumeral periarthritis, cervical spondylopathy, and arthromyodynia.
    • Most subjects in these studies did not respond to the conventional therapies for their problems.
    • Qigong therapy (self practice or external qi therapy) produced significant improvement or complete cure for 40% to 75% of patients in the reviewed studies.
    Chen & Liu , Medical Paradigm . 2004, 1(1): 36-48.
  • 37. Qigong Therapy for Cancer
    • Chen & Yueng reviewed 50+ research studies of qigong therapy for cancer in the past 20 years.
    • Group treated with qigong had significant more improvement or a better survival rate than those treated with conventional method, with less side effects.
    • The cancer cells used in-vitro and in-vivo include breast cancer, erythroleukemia (K562), leukemia, CNE-2, SGC-7901 gastric adenocarcinoma, spleen cells, lung tumor cells (LA-795), etc.
    • Most studies demonstrated the inhibitory effect of qigong on the growth of cancer cells in comparison with the control and sham-treated groups.
  • 38. Challenges in Conducting RCTs with Qigong Therapy
    • Hard to find the compatible control for qigong meditation (time & attention)
    • Quality of meditation affects outcomes – how to monitor the compliance or quality?
    • Not a simple intervention, but a lifestyle, or attitude change --- need motivation for long commitment, & observation of long-term outcomes
    • Lack of standardization --- various forms may have different effects
    • Repeatability problem in actual studies….
  • 39. How to conduct scientific research of Qigong? Introduction to my scientific exploration of Qigong therapy
  • 40. EQT on Transplanted Hepatocarcinoma in Mice
    • 30 nude mice injected w/ hepatocarcinoma cells.
    • randomly assigned into 3 groups: control, sham & external qigong treatment.
    • EQT towards mouse cage (10-15 am away) 10 minutes every other day, a total of 4 sessions.
    • Mice sacrificed 72 hrs after last EQT. Tumor mass isolated & weighted.
    • The three repeated trials showed, compared with control the tumor growth-inhibitory rates of EQT group were 70%, 80%, and 79%, respectively (p < 0.0001).
    Chen et al. 1997, Asian Medicine, 11, 36-38
  • 41.  
  • 42. Inhibition of Cell Culture Growth
    • Study of EQT inhibiting breast cancer cell growth (PPT-I expression).
    • 4 BC cell lines (BC-123; BC-125; BC-HT-20; BC-T47d) were grown in 4 conditions.
    • All plates were re-incubated for 16 hours. Total RNA was extracted to determine the levels of beta-PPT-I.
    • Treatment: Qigong (10 min), sham (10 min), incubator control & room temperature control.
  • 43. Results of Our In-Vitro Study
    • Compared to sham-treated cells, the closest control, in all 8 trials (4 BC cells in two trials) the Qi-treated cells had slower growth than all sham group (p = .0038 in cumulative binomial probability distribution)
  • 44. Qigong for OA at Knees --- a NIH-funded study
    • Based on the promising pilot result, we have received a NIH grant to conduct a duel-blind placebo-control clinical study to examine the therapeutic effect of external qi therapy for OA at knees.
    • 1 12 OA patients were randomized into two treatment conditions: real qigong or sham qigong, -- 5-6 treatments in 2 weeks. Then, a 3-month follow-up.
    • Key outcomes: WOMAC, MPQ-SF & Anxiety
  • 45.  
  • 46. Changes in WOMAC Pain Scores
  • 47. Changes in WOMAC Functional Difficulty Scores
  • 48. Qigong Therapy for Heroin Addicts
    • 86 male heroin addicts (age 18 to 52) who met DSM-III-R were randomly assigned into one of the 3 groups: Qigong, medicine (lofexidine-HCI, 0.2 mg), and non-treatment control.
    • Measures: Urine morphine test (daily), Hamilton anxiety scale (every 5 th day), withdrawal symptom scale (23 items checklist – daily).
    • Qigong intervention: Self practice of qigong 2 to 2.5 hours daily, plus external qi adjustment 15 minutes daily without any medication.
    Li, Chen & Mo (2002) Alternative Therapies in Health and Medicine , 8(1): 50-59
  • 49.  
  • 50. Hamilton Anxiety Scores by Group * ** * * p < .01 compared to control group ** p < .05 compared to both control and medication groups
  • 51. How Qigong Works ? -- A long way to go….
    • Scientifically verified mechanisms (Chen & Yueng, 2002):
    • Qigong therapy may improve immune functions – confirmed by in-vitro , in-vivo and human studies
    • Qigong practice may increase micro-circulation functions (more efficient metabolism)
    • Qi energy may direct turn off the cancer cells and produce apoptosis effect ( in-vivo studies)
    • Qigong therapy can raise the pain threshold – confirmed by in-vivo and human studies
  • 52. Explore the Mechanisms  Respiratory rate -- calm down the entire body (Ng & Tsang. 2009)  Respiratory rate to get more oxygen  Blood pressure with adjusted autonomic nervous system (Paul-Labrodor et al. 2006)  Blood pressure to supply blood efficiently  NK activity,  WBC count,  lymphocytes,  antibody (Ng & Tsang. 2009; Yang et al. 2008)  Immune system,  WBC count  heart rate,  HRV balanced blood supply (Ng & Tsang. 2009)  Heart rate to supply more blood quickly Qigong Effects Stress Response/Effect
  • 53. Explore Mechanisms (con’t)  Anxiety and depression (Ng & Tsang. 2009; Li et al. 2002)  Negative mood/affect  Interleukin (IL-6) (Pace et al. 2009)  Interleukin (IL-6) indicator of Inflammation  Insulin resistance (Paul-Labrodor 2006)  total cholesterol (Ng & Tsang. 2009) Deficient production of insulin,  risk of obesity  cortisol,  melatonin (Lee et al. 2001; Guo 1996)  Adrenaline and cortisol (hormone response) Qigong Effects Stress Response/Effect
  • 54. TCM Explanation of Qigong
    • Motivated Qi (vital energy) strikes against sick locations
    • Cultivation of yi (consciousness and intention) and “empty mind without desire” can help practitioners strengthen their intention power, release suppressed emotions, and resolve mental disturbances
    • Rapidly uncover the body’s self-healing potential, including the immune functions, the self-repair capability and self-regeneration ability.
  • 55. Yin-Yang Perspective of the World & Diseases Mind/ Psyche (Anti-matter) Physical Body (Matter) Energy Channels -- the “S” Line
  • 56. Qigong and Healthcare
    • Qigong represents the essence of TCM – self-responsibility and self-healing
    • The U.S. healthcare reform focuses on broad coverage and cost control in sickness care
    • Preventive medicine is the key to the control of healthcare cost, & bring a real sense of health
    • Advocate self-care like Qigong will bring lifestyle change, a new perspective to the field….
  • 57. Survey of Annual Healthcare Cost per person (1992-95) N = 500 Average annual saving: 83.4% 232 (46%) no medical cost Source: China Qigong Science 1996, 10, 29-30
  • 58. Ancient Wisdom on Life-Nurturing
    • “ Remain detached and empty-minded
    • Genuine qi would flow easily,
    • Keep essence-spirit within
    • No illness will arise.”
    • 恬淡虚无,真气从之,精神内守,病安从来
    • -- Yellow Emperor's Internal Classic, 500 B.C.
  • 59. Selected References
    • Chen K, & Yeung R, 2002. &quot;Exploratory studies of qigong therapy for cancer in China.&quot; Integrative Cancer Therapies. 1(4):345-370.
    • Cohen, Kenneth, 1997. The Way of Qigong . Ballantine Wellspring Publisher.
    • Sancier KM. 1996. “Medical Applications of Qigong.” Alternative Therapies in Health & Medicine , 2(1): 40-45.
    • Chen K, 2004, “Analytic review of studies measuring external qi in China.’ Alter Therapies in Health & Medicine , 10(4): 38-50.
    • Chen K, & Liu T, 2004. “Effects of qigong therapy on arthritis: A review and report of a pilot trial.” Med Paradigm 1, 36-48.
    • Chen K , “Qigong therapy for stress management.” Pp. 428-48 in Lehrer et al. (eds.) Principals & Practice of Stress Management , 3rd Ed. New York: Guilford Publications. 2007.
  • 60. More References
    • Chen K. et al. (2010). “ Introducing Qigong meditation into residential addiction treatment: A pilot study where gender makes a difference.” J of Alternative & Complementary Medicine. 16(8): 875-882.
    • Paul-Labrador M. et al. (2006). Effects of a RCT of TM on components of metabolic syndrome in subjects with coronary heart disease. Arch. Internal Med , 166, 1218-1224
    • Ng BH & Tsang HW (2009). Psychophysiological outcomes of health qigong for chronic conditions: A systematic review. Psychophysiology , 46
    • Yang Y et al. (2008) Effects of a traditional taiji/qigong curriculum on older adults' immune response to influenza vaccine. Med Sport Science ; 52: 64-76.