Qigong in mental healthcare
Colorado Integrative Medicine
Conference
July, 2009
James Lake M.D.
www.IntegrativeMentalHealth.net
Qigong in mental health care
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What is qigong?
Early origins
Qigong and Chinese medical theory
Western scientific theories of mechanism
Safety issues (yes, there are some)
Qigong for maintaining good mental health
Qigong in Rx of mental illness
Formulating a qigong Rx plan
Finding a qualified qigong doctor
Qigong
What it is and where it came from
What is qigong?
• Spiritual practice based on assumptions about
“energetic” nature of the body
• Western medicine assumes universe explainable
viz matter and classical forms of energy
• Chinese medicine posits irreducible energetic
“essences”
• “Balance” between energies determines health
or illness
• A sound mind and a healthy body are inseparable
and interdependent
Origins
• Healing forms like qigong widely practiced in
China as early as 2000 BCE
• Evolved from Yoga or Tibetan Buddhist
practices
• Historical and philosophical roots of Qigong
inseparable from principles of Chinese
medicine
• “Qigong” first used in its present meaning in
early in the 20th century
Qigong according to TCM
• “Qi” is one of three fundamental kinds of
energy needed for health and healing
• The other two, Shen (Spiritual energy), and
Jing (sexual energy), are considered the yang
(ascending, bright, active) and yin
(descending, dark, passive) aspects of qi
• Jing, Qi, and Shen can be understood as body,
mind, and spirit, respectively
Nutritive qi and original qi
• Qi derives from three basic sources: food,
breath, and body’s genetic constitution
• Food and breath combine to form “nutritive
qi,” which flows through meridians and is
altered during acupuncture treatments
• Inherited make-up of physical body is “original
qi”
• Jing is “essence” or “the original source of life
and growth”
Qigong restores optimum balance
• Qigong strives to restore optimum balance
between yin and yang elements of the biological,
spiritual and energetic aspects of the body
• Three stages in development of skill to “build up”
or manipulate and transform qi:
• converting Jing into Qi (“nourishing the Jing”)
• converting Qi into Shen (“nourishing the Shen”)
• refining the Shen to govern emotions (“refining
the Shen”)
How qigong works
• Qigong exercises strengthen one or more dan
tien or convert one energetic principle into
another where deficiency or imbalance exists
• The three dan tien (“fields of the elixir”) are
principle storage sites of jing, qi and shen
• “Building up,” strengthening, or propelling qi
energy to different body regions, and
transforming various “types” of energy into
others, originate in the dan tien
Maintaining optimal balance
• When qigong done correctly “three treasures”
remain in optimal balance
• Optimum energetic balance manifests as
prolonged good health and calm, centered
state of mind
• Individuals who achieve optimum energetic
balance may develop capacity to affect
energetic balance of people or objects
through touch or intention
Many qigong styles
• Hundreds of qigong “styles” for disease
prevention or health promotion
• Different styles use various combinations
of physical movements, breathing
exercises or directed intention to
regulate flow of qi to achieve optimum
balance of yin and yang energy for a
specific health problem
Qigong not widely accepted among
TCM practitioners
• After Cultural Revolution qigong became
increasingly popular in the west
• Many practitioners of Chinese medicine
reject qigong and do not use qigong as Rx
• Probably due to absence of qigong
“technology” in contrast to exact
protocols for acupuncture, moxa or
herbal formulas
Role of suggestibility
• Healer-patient relationship similar in qigong
and shamanic healing practices because
suggestibility or shared cultural beliefs
determine effectiveness (Kleinman)
• However research findings consistently show
that suggestibility does not adequately
explain beneficial health effects of qigong
Medical qigong
First principles
Medical qigong
• Individuals who learn how to skillfully
manipulate qi can learn specific
techniques of medical qigong
• Medical qigong is deliberate
manipulation of qi to maintain good
health or treat illness
• Can be self-directed or outwardly
directed “emission” qigong
Health and illness in Chinese medical
theory
• Health and illness are manifestations of
relative strength and balance between
energetic principles
• External field of “protective energy” (wei qi)
emanates from all living things
• Internal stresses (psychological traits, strong
emotions) and external “stresses” (diseasecausing organisms, toxic substances) damage
protective field resulting in illness
Wei qi
• Disruption of wei qi can result in “toxic
energy” or “depletion” of desirable energy,
manifesting as physical, emotional sx
• Emotional stress and neglect of physical
health result in diminished qi
• Qigong yields beneficial effects when selfdirected qigong practice or emission qigong Rx
replenishes or re-balances qi energetic
patterns, restoring wei qi
Medical qigong—evidence
• Reports of efficacy in breast cancer, other
malignancies, disorders of kidney, lungs and
liver, and Parkinson’s Disease
• May accelerate post-CVA recovery (Weintraub
2001) and reverse cerebral atrophy (Zhao
1988)
• Standardized Rx protocols developed for
select medical and psychiatric disorders
Qigong and mental health
Energy and balance
Qi and mental health
• Failure to resolve intense emotions blocks
optimum qi circulation, resulting in deficiency
or accumulation of “toxic energy” in certain
organs or physiological functions
• Deficient or “toxic” qi manifests as emotional
or psychosomatic symptoms
• Treatment of sx caused by “toxic energy”
strives to release excess qi or strengthen
deficient qi
Qigong in mental health
• Imbalances of qi, shen or jing manifest as
physical, emotional or psychosomatic sx
• Most psychiatric sx result from
“deviations” in Shen energy—an inherent
“force” of CNS
• “Skillful” qigong practice has sustained
positive effects on psychiatric disorders
Qigong in mental health—concepts
• Yuan Shen is innate or “inherited” spiritual
pattern of the individual and connection to
divine energy of the universe
• Zhi Shen corresponds to beneficial or toxic
thought patterns acquired following birth
• Yuan Shen resides in the brain, while the Zhi
Shen resides in the heart
Qigong in mental health—concepts
• Yuan Shen (mind) rules over the Zhi Shen
(heart)
• Imbalances of Yuan Shen and Zhi Shen
manifest as different psychological or
emotional symptoms
• Work of the qigong master or qigong practice
is to correct imbalances through appropriate
qigong exercises
Maintaining good mental health
• Qigong practitioners and individuals who
receive qigong Rx report “release” of
emotional tension
• Longer practice improves energetic “balance”
and improved physical and mental health
• Practicing qigong consistently and skillfully
brings peacefulness, resilience and improved
capacity to cope with stress
Maintaining good mental health
• Qigong practice enhances body awareness
including somatic sx of emotional distress
• Improved awareness of muscle tightness
through qigong practice may give insight into
stresses or conflicts underlying somatic sx
• Improved awareness gives choice of changing
circumstances or exploring conflicts and can
be adjunct to psychotherapy
Medical qigong research
Competing theoretical perspectives
Theories of mechanism
• Effects on brain electrical activity or
regional cerebral blood flow found with
therapeutic effects (Ng & Tsang 2009)
• Beneficial endocrinological and
immunologic effects
• Beneficial changes in blood pressure,
GSR, blood levels of certain
neurotransmitters
Theories of mechanism
• Correlations between qi and intensity,
frequency and wavelength of sound, heat,
light and electromagnetic fields
• Magnetic field between hands of qigong
healers roughly 1000 times stronger than
magnetic field generated by beating heart
• DNA might be capable of generating and
detecting weak coherent magnetic fields
Qigong—proposed mechanisms
• Specialized kind of meditation associated with
EEG changes corresponding to deep relaxation
and improved mental clarity (but cannot
explain positive changes from external qigong
Rx in randomized protocols)
• “Rebalances” qi by sending infrasonic
vibrational energy into meridians affecting
immunologic or autonomic functioning
resulting in improved health
Verifying existence of qi
• Problem of verification related to conceptual and
methodological differences between TCM and
western science
• Conceptual differences limit study designs on
qigong which posits phenomena not explainable
or measurable by Western science
• Chinese researchers accept that qigong practice
generates fundamental energetic principle and do
not design elaborate controlled studies
Optimization of EEG activity
• Qigong meditation and external qigong increase
alpha power, enhance alpha synchronization
between brain regions, and shift frontal EEG to
dominant alpha frequency (Lee 1999)
• During qigong practice or external Rx neo-cortex
relatively inhibited, autonomic brainstem activity
relatively increased
• Mechanism involves optimization of autonomic fx
improving “balance” and “integration” of
sympathetic and parasympathetic functions
Coherent information “field”
• Highly organized microscopic biochemical
structures, including possibly DNA molecules
and constituents of axons in the CNS (Penrose
1994) generate weak coherent magnetic fields
• Resulting fields “interact” with fields of other
organisms, imparting “information” resulting
in subtle autonomic changes manifesting as
improved “energetic balance” and “health”
Limitations on research
• Difficulty designing double-blind studies
on emission qigong therapy
• “Sham” qigong masters and true masters
may appear identical
• Double-blind studies of emission qigong
must be designed so no differences
between sham and actual Qigong
Masters evident
Unresolved research issues
• Qigong practitioners assigned to
“experimental” groups probably have
characteristics that improve health
• General health-promoting factors obscure
efficacy of qigong for specific disorders
• Emission qigong or sham Rx groups not selfselected and do not share values or beliefs
that improve outcomes
Research on brain function
• Consistent increases in urinary catecholeamines
in eleven subjects practicing qigong (Litscher
2001)
• Correlation between duration of qigong practice
and increase in urinary catecholeamines suggests
qigong practice increases sympathetic activity
• Positive relationship between qigong meditation
or emission qigong Rx and enhanced alpha EEG
activity in the prefrontal cortex (Litscher 2001)
Research on CNS—mechanisms
• Increased electrical activity in brainstem
and hypothalamus following qigong
practice, and inhibition of several areas
of the cerebral cortex (Litscher 2001)
• Similar changes in anesthetized cats
receiving emission qigong treatments,
eliminating suggestion as factor (Liu
1990)
Infrasonic sound
• Infrasonic sound detected from Qigong
masters during emission qigong Rx
• Researchers concluded emitted qi
manifested as high-decibel sound energy
that “causes” EEG changes in cerebral cortex,
brainstem and other brain regions (Liu 1990)
• Findings limited by small size, absence of
controls and no blinded raters
Increased alpha activity and metabolism
• PET and EEG examined relationships
between brain electrical activity and
regional cerebral blood (rCBF) flow in
qigong practitioner (Manabu 1996)
• Increases in frontal alpha and beta
correlated with increased rCBF
• Findings limited by single subject and no
control
More studies needed to:
• Confirm consistent beneficial effects of qigong
practice or emission qigong Rx on EEG and
rCBF
• Clarify mechanism(s) of action
• Examine putative correlations between
general CNS effects and apparent clinical
improvements in psychiatric or medical
disorders
Future studies on qigong
• Need to be rigorously designed including
sham qigong masters
• Should examine EEG, rCBF, and structural
CNS effects
• Should distinguish between individual
qigong practitioners and patients
receiving emission qigong Rx
Safety
Precautions and contra-indications
Safety
• No studies assessing long term safety
issues or contra-indications
• Review of literature from both
English and Chinese language
sources revealed no absolute
contraindications of qigong practice
or external qigong Rx
Qigong adverse effects
• Transient AEs : itching, swaying, “clicking” in
joints, perspiration, muscle soreness,
drowsiness, restlessness
• Transient nausea, dizziness, tremors,
headaches
• “Qi deviations” are physical or emotional sx
resulting from unskillful qigong practice: weak
constitution; deviations in posture or
respiration; suspiciousness; excessive thinking
Qigong relative contra-indications
• Avoid strenuous qigong practice during
pregnancy, menstruation
• Avoid qigong practices that increase “heat”
when inflammatory or infectious condition
• Avoid passive qigong exercises where
hemorrhoids, varicose veins or chronic pain
• Avoid slow abdominal breathing in diabetes or
kidney failure
Risks of erroneous qigong
• Chinese Classification of Mental Disorders
describes psychological disturbances due to
“erroneous qigong” (Ng 1999)
• DSM-4 describes “qigong psychotic reaction”
as culture-bound syndrome
• Transient psychosis may result from
“erroneous” practice of qigong
• “Unskillful” or “excessive” practices can cause
psychological or somatic sx
Can exacerbate psychiatric disorders
• Fragile patients may report inappropriate
laughing and crying, unusual movements,
weakness
• Borderline PD may have dissociative or
psychotic sx, suicidal impulses
• Pts dx’d with psychotic D.O. or severe
personality disorder should avoid qigong
practice and not receive qigong Rx
Qigong for psychiatric disorders
Review of evidence
Techniques for treating and preventing
mental health problems
• Medical qigong widely practiced to prevent
anxiety, depression and other sx
• Principle energetic methods for healing
emotional trauma:
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emission” qigong therapy by qigong doctor
energetic massage
breath-centered work
dynamic postural therapy
qigong meditation
Qigong in maintaining good mental
health
• 35 healthy subjects who regularly practiced
qigong reported enhanced “quickness and
flexibility” in memory and attention tasks (Wang
1990)
• 226 healthy subjects who practiced qigong daily
reported improved “emotional stability, increased
joy of life, decreased selfishness, more open
attitude, increased interest, increased will power,
and increased care about others (Hayashi 1995)”
Qigong adjunct to psychotherapy
• Case reports of improved outcomes in
“neuroses, depression, anxiety, and
psychosomatic disorders when qigong
used with psychotherapy (Geibler 1998)”
• But “unskillful” application of qigong in
Rx of schizophrenia and other severe
mental illness
Qigong for depressed mood
• 122 elderly qigong practitioners and 55
subjects who practiced Taijiquan compared to
age-matched subjects who had never
practiced qigong or Taijiquan (Tang et al 1990)
• Qigong group reported improved mood,
reduced anxiety, improved sleep
• Type-A behavior moderated in patients who
practiced qigong at least five years
Duration of practice
• Prospective open study (Wang 1993)
compared psychological variables in group
practicing qigong for less than two years (N =
153) with group practicing longer than two
years (N = 119)
• Variables measured: “somatization, obsessivecompulsive tendencies, interpersonal
sensitivity, depression, anxiety, hostility,
phobic anxiety,” others
Duration of practice
• Significantly greater improvement in
group practicing longer than two years
for all measures including depression and
anxiety
• Improvements in baseline psychological
and emotional state corresponded to the
duration of qigong practice
Depressed mood in Parkinson’s disease
• Ten-week open study examined qigong
on quality of life, neurologic sx, mood in
17 pts dx’d with P.D. (Schwartzman
1998).
• 13 pts reported improved mood but no
changes in quality of life, neurologic sx
• 9 experienced 25 to 50% improvement
from pre-treatment baseline
Qigong for anxiety
• 2 wk open study on 35 pts dx’d “neurosis,
headaches, anxiety” practiced qigong vs
matched individuals receiving EMG
biofeedback (Li et al. 1988)
• Outcome measures: ratings of “heating,
relaxation, awakening, calm, saliva increase,
quick thinking, sense of light body, sense of
well-being.”
• Subjective stress significantly lower among
male qigong practitioners but not females
Qigong for anxiety
• Prospective open study examined
changes in BP, temperature, HRV and
state anxiety in 13 subjects following
qigong (Kato 1992)
• Increased sympathetic and decreased
parasympathetic activity (but no changes
in BP or temp) corresponding to
decreased anxiety
Qigong for anxiety
• Open trial (qigong 15 mins/day) 8 pts dx’d
with unspecified DSM-III anxiety D.O.s (Shan
et al; 1989)
• EEG, GSR, respiration rate, pulse and oxygen
consumption before and after qigong
• Findings: increased alpha amplitude,
decreased HR, BP, RR, significant sustained
improvements in HAM-A in 5 pts
Qigong for anxiety
• 8 wk open pilot weekly Tai-Chi vs progressive
muscle relaxation in 8 combat vets dx’d with
P.T.S.D. (Hutton et al; 1996)
• Tai-chi group had significantly greater
decrease in subjective distress, greater
decrease in heart rate
• Better adherence in Tai-chi group, which
biased toward positive outcomes
GAD and panic
• Anxiety associated with “descent of the Water
qi” related to a pathological disturbance of
kidney’s Jing energy
• Mayer (Mayer 1997) developed integrative rx
of generalized anxiety and panic attacks
combining depth psychotherapy, Western
relaxation techniques, cognitive restructuring
and qigong
Qigong for other psychiatric
disorders
Review of evidence
Qigong for childhood ADHD
• Open prospective study on effects of qigong
breathing exercises on “aggression, attention and
restlessness” in primary school-age children
(Cousins 1999).
• Teachers interviewed during and 2 mos after
qigong training; no pre- or post-study formal
psychological assessments
• Teachers perceived most children as less restless
and more attentive on qigong practice days
Qigong for ADHD
• Many children reported “full of energy” on
qigong practice days
• Teachers able to consistently redirect children
from aggressive behaviors using qigong breathing
exercises
• Behavioral changes resulted in significantly
greater ease in managing inattentive or disruptive
behaviors
• Findings limited by absence of matched controls,
blind raters, absence of formal ADHD diagnoses
Qigong for heroin withdrawal
• 86 heroin addicts randomized to qigong 2
hrs/day vs medication for detox fx
symptomatic care (Li et al 2002)
• Pre-rx and daily EKG, withdrawal sx and
anxiety assessed. Qigong group experienced
more rapid reduction in withdrawal sx,
significantly lower anxiety and greater
improvement in sleep quality
Qigong for psychosomatic sx
• Retrospective case review examined 25
selected cases of Shen qigong as a rx of
irritable bowel syndrome, premenstrual
distress, and psychogenic pain (Pavek 1988)
• Author reported consistent success relieving
migraines, chronic low back pain, other
psychosomatic symptoms caused by repressed
emotions
Formulating qigong treatment plan
General principles
Prescribing medical qigong
• Medical qigong does not offer specific
standardized treatment protocols
• Most efficacious emission qigong rx or qigong
practice technique depends on unique
energetic imbalances of each patient
• Self-directed and “emission” qigong rx for
emotional sx described for phobias, anxiety,
stress-related sx, anger, and grief or sorrow
Condition-specific qigong rx
• Important tasks of qigong doctor are
educating patient and taking complete
“energetic” hx to diagnose underlying
energetic imbalance(s)
• Rx recommendations based on relationships
between emotions and five Yin organs (Eg.
Liver associated with anger, other “negative”
emotions)
Planning Rx for psycho-emotional
symptoms
• Most psycho-emotional sx result from
Shen disturbances
• “Calming the Shen” most important goal
of emission qigong rx
• Important to distinguish self-treatment
by qigong practice from emission qigong
rx from qigong master
Qigong for cultivating good mental
health
• Qigong practitioners strive to:
– Cultivate good mental health through
regular practice of specific meditation
and postural techniques
–This is called “mental dao yin training”
and preserves mental tranquility and
emotional balance
Advanced techniques
• Advanced practitioners use specific
meditation techniques to transform
destructive emotional patterns into “healthy”
patterns using visualization
• Pursuing these teachings with intensity and
discipline eventually brings practitioner to
deep spiritual insights, and personal
transformation
Certification and finding qualified
qigong doctors
Where to look
Finding qualified qigong practitioner
• In China certification requires completion of
rigorous three-year program and internship
• Few rigorous training programs in medical
qigong exist in the West
• Some TCM colleges offer medical qigong
courses or certification training programs
• Western medical qigong training programs
highly variable in duration and content
Medical qigong certification
• First free-standing medical qigong clinic Five
Branches Institute of TCM, Santa Cruz, 2000
• State Medical Boards do not screen medical
qigong practitioners because criteria for
certification not established
• Well-known medical qigong instructors certify
students based on rigorous examinations and
supervised training in clinical settings
Qigong exercises
A few simple forms