Qigong
Qigong (), qi gong, chi kung, chi 'ung, or chi gung () is a system of coordinated body-posture and movement, breathing, and meditation used for the purposes of health, spirituality, and martial-arts training. With roots in Chinese medicine, philosophy, and martial arts, "qigong" is traditionally viewed by the Chinese and throughout Asia as a practice to cultivate and balance qi (pronounced approximately as "chi" or "chee"), translated as "life energy". "Qigong" practice typically involves moving meditation, coordinating slow-flowing movement, deep rhythmic breathing, and a calm meditative state of mind. People practice "qigong" throughout China and worldwide for recreation , exercise, relaxation, preventive medicine, self-healing, alternative medicine, meditation, self-cultivation, and training for martial arts. Etymology. "Qigong" (Pinyin), "ch'i kung" (Wade-Giles), and "chi gung" (Yale) are Romanized words for two Chinese characters: qì ('／') and gōng (). "Qi" (or "chi") primarily means air, gas or breath but is often translated as a metaphysical concept of 'vital energy', referring to a supposed energy circulating through the body; though a more general definition is universal energy, including heat, light, and electromagnetic energy; and definitions often involve breath, air, gas, or the relationship between matter, energy, and spirit. "Qi" is the central underlying  principle in traditional Chinese medicine and martial arts. "Gong" (or "kung") is often translated as cultivation or work, and definitions include practice, skill, mastery, merit, achievement, service, result, or accomplishment, and is often used to mean gongfu (kung fu) in the traditional sense of achievement through great effort. The two words are combined to describe systems to cultivate and balance life energy, especially for health and wellbeing. The term "qigong" as currently used was promoted in the late 1940s through the 1950s to refer to a broad range of Chinese self-cultivation exercises, and to emphasize health and scientific approaches , while de-emphasizing spiritual practices, mysticism, and elite lineages. History and origins. With roots in ancient Chinese culture dating back more than 4,000 years, a wide variety of "qigong" forms have developed within different segments of Chinese society: in traditional Chinese medicine for preventive and curative functions; in Confucianism to promote longevity and improve moral character; in Daoism and Buddhism as part of meditative practice; and in Chinese martial arts to enhance self defending abilities. Contemporary "qigong" blends diverse and sometimes disparate traditions, in particular the Daoist meditative practice of "internal alchemy" (Neidan ), the ancient meditative practices of "circulating qi  (Xing qi ) and standing meditation" (Zhan zhuang ), and the slow gymnastic breathing exercise of "guiding and pulling" (Dao yin ). Traditionally, "qigong" was taught by master to students through training and oral transmission, with an emphasis on meditative practice by scholars and gymnastic or dynamic practice by the working masses. Starting in the late 1940s and the 1950s, the mainland Chinese government tried to integrate disparate "qigong" approaches into one coherent system, with the intention of establishing a firm scientific basis for "qigong" practice. In 1949, Liu Guizhen established the name "Qigong" to refer to the system of life-preserving practices  that he and his associates developed, based on Dao yin and other philosophical traditions. This attempt is considered by some sinologists as the start of the modern or scientific interpretation of "qigong". During the Great Leap Forward (1958–1963) and the Cultural Revolution (1966–1976), "qigong", along with other traditional Chinese medicine, was under tight control with limited access among the general public, but was encouraged in state-run rehabilitation centers and spread to universities and hospitals. After the Cultural Revolution, "qigong", along with t'ai chi, was popularized as daily morning exercise practiced en masse throughout China. Popularity of "qigong" grew rapidly  during the Deng and Jiang eras after Mao Zedong's death in 1976 through the 1990s, with estimates of between 60 and 200 million practitioners throughout China. Along with popularity and state sanction came controversy and problems: claims of extraordinary abilities bordering on the supernatural, pseudoscience explanations to build credibility, a mental condition labeled "qigong" deviation, formation of cults, and exaggeration of claims by masters for personal benefit. In 1985, the state-run National Qigong Science and Research Organization was established to regulate the nation's "qigong" denominations. In 1999, in response to widespread revival of old traditions of spirituality , morality, and mysticism, and perceived challenges to State control, the Chinese government took measures to enforce control of public "qigong" practice, including shutting down "qigong" clinics and hospitals, and banning groups such as Zhong Gong and Falun Gong. Since the 1999 crackdown, "qigong" research and practice have only been officially supported in the context of health and traditional Chinese medicine. The Chinese Health Qigong Association, established in 2000, strictly regulates public "qigong" practice, with limitation of public gatherings, requirement of state approved training and certification of instructors, and restriction of practice to state-approved forms. Through the forces of migration  of the Chinese diaspora, tourism in China, and globalization, the practice of "qigong" spread from the Chinese community to the world. Today, millions of people around the world practice "qigong" and believe in the benefits of "qigong" to varying degrees. Similar to its historical origin, those interested in qigong come from diverse backgrounds and practice it for different reasons, including for recreation, exercise, relaxation, preventive medicine, self-healing, alternative medicine, self-cultivation, meditation, spirituality, and martial arts training. Overview. Practices. "Qigong" comprises a diverse set of practices that coordinate body (), breath (), and mind () based on Chinese philosophy. Practices include moving  and still meditation, massage, chanting, sound meditation, and non-contact treatments, performed in a broad array of body postures. "Qigong" is commonly classified into two foundational categories: 1) dynamic or active "qigong" ("dong gong"), with slow flowing movement; and 2) meditative or passive "qigong" ("jing gong"), with still positions and inner movement of the breath. From a therapeutic perspective, "qigong" can be classified into two systems: 1) internal "qigong", which focuses on self-care and self-cultivation, and; 2) external "qigong", which involves treatment by a therapist who directs or transmits "qi". As moving meditation, "qigong" practice typically coordinates slow  stylized movement, deep diaphragmatic breathing, and calm mental focus, with visualization of guiding "qi" through the body. While implementation details vary, generally "qigong" forms can be characterized as a mix of four types of practice: dynamic, static, meditative, and activities requiring external aids. Forms. There are numerous "qigong" forms. 75 ancient forms that can be found in ancient literature and also 56 common or contemporary forms have been described in a "qigong" compendium. The list is by no means exhaustive. Many contemporary forms were developed by people who had recovered from their illness after "qigong" practice. Most of the "qigong  forms come under the following categories: Development of health "qigong"". In 1995, there was Qigong Talent Bank, an organization of Science Research of Chinese Qigong, functioning as network system of the senior Chinese qigong talents in China. In order to promote "qigong" exercises in a standardised and effective way with a scientific approach, The Chinese Health Qigong Association (CHQA) appointed panels of Qigong experts, Chinese medicine doctors and sport science professors from different hospitals, universities and "qigong "lineage across China to research and develop new sets of "qigong" exercises. In 2003 the CHQA officially promoted a new system called "health  qigong", which consisted of four newly developed health qigong" forms: In 2010, the Chinese Health Qigong Association officially introduced five additional health "qigong" forms: Other commonly practised "qigong" styles and forms include: Techniques. Whether viewed from the perspective of exercise, health, philosophy, or martial arts training, several main principles emerge concerning the practice of qigong: Additional principles: Advanced goals: The most advanced practice is generally considered to be with little or no motion. Traditional and classical theory. Over time, five distinct traditions or schools of "qigong" developed in China, each with its own theories and characteristics: Chinese Medical Qigong, Daoist  Qigong, Buddhist Qigong, Confucian Qigong, and Martial Qigong. All of these "qigong" traditions include practices intended to cultivate and balance qi. Traditional Chinese medicine. The theories of ancient Chinese "qigong" include the Yin-Yang and Five Phases Theory, Essence-Qi-Spirit Theory, Zang-Xiang Theory, and Meridians and Qi-Blood Theory, which have been synthesized as part of Traditional Chinese Medicine (TCM). TCM focuses on tracing and correcting underlying disharmony, in terms of deficiency and excess, using the complementary and opposing forces of yin and yang (), to create a balanced flow of "qi". "Qi" is believed to be cultivated and  stored in three main dantian energy centers and to travel through the body along twelve main meridians (Jīng Luò ), with numerous smaller branches and tributaries. The main meridians correspond to twelve main organs ) (Zàng fǔ ). "Qi" is balanced in terms of yin and yang in the context of the traditional system of Five Phases (Wu xing ). A person is believed to become ill or die when "qi" becomes diminished or unbalanced. Health is believed to be returned by rebuilding "qi", eliminating "qi" blockages, and correcting "qi" imbalances. These TCM concepts do not translate readily to modern science and medicine. Daoism . In Daoism, various practices now known as Daoist "qigong" are claimed to provide a way to achieve longevity and spiritual enlightenment, as well as a closer connection with the natural world. Buddhism. In Buddhism meditative practices now known as Buddhist "qigong" are part of a spiritual path that leads to spiritual enlightenment or Buddhahood. Confucianism. In Confucianism practices now known as Confucian "qigong" provide a means to become a Junzi () through awareness of morality. Contemporary qigong. In contemporary China, the emphasis of "qigong" practice has shifted away from traditional philosophy, spiritual attainment, and folklore, and increasingly to health benefits, traditional  medicine and martial arts applications, and a scientific perspective. "Qigong" is now practiced by millions worldwide, primarily for its health benefits, though many practitioners have also adopted traditional philosophical, medical, or martial arts perspectives, and even use the long history of "qigong" as evidence of its effectiveness. Contemporary Chinese medical qigong. "Qigong" has been recognized as a "standard medical technique" in China since 1989, and is sometimes included in the medical curriculum of major universities in China. The 2013 English translation of the official Chinese Medical Qigong textbook used in China defines CMQ as "the skill of body-mind exercise  that integrates body, breath, and mind adjustments into one" and emphasizes that "qigong" is based on "adjustment" (tiao , also translated as "regulation", "tuning", or "alignment") of body, breath, and mind. As such, "qigong" is viewed by practitioners as being more than common physical exercise, because "qigong" combines postural, breathing, and mental training in one to produce a particular psychophysiological state of being. While CMQ is still based on traditional and classical theory, modern practitioners also emphasize the importance of a strong scientific basis. According to the 2013 CMQ textbook, physiological effects of "qigong" are numerous, and include improvement of respiratory  and cardiovascular function, and possibly neurophysiological function. Conventional medicine. Especially since the 1990s, conventional or mainstream Western medicine often strives to heed the model of evidence-based medicine, EBM, which demotes medical theory, clinical experience, and physiological data to prioritize the results of controlled, and especially randomized, clinical trials of the treatment itself. Although some clinical trials support qigong's effectiveness in treating conditions diagnosed in Western medicine, the quality of these studies is mostly low and, overall, their results are mixed. Integrative, complementary, and alternative medicine. Integrative medicine (IM) refers to "the blending of conventional and complementary medicines and  therapies with the aim of using the most appropriate of either or both modalities to care for the patient as a whole", whereas complementary is using a non-mainstream approach together with conventional medicine, while alternative is using a non-mainstream approach in place of conventional medicine. "Qigong" is used by integrative medicine practitioners to complement conventional medical treatment, based on complementary and alternative medicine interpretations of the effectiveness and safety of "qigong". Scientific basis. Scientists interested in "qigong" have sought to describe or verify the effects of "qigong", to explore mechanisms of effects, to form scientific theory with respect  to "qigong", and to identify appropriate research methodology for further study. In terms of traditional theory, the existence of "qi" has not been independently verified in an experimental setting. In any case, some researches have reported effects on pathophysiological parameters of biomedical interest. Practitioners, uses and cautions. Recreation and popular use. People practice "qigong" for many different reasons, including for recreation, exercise and relaxation, preventive medicine and self-healing, meditation and self-cultivation, and training for martial arts. Practitioners range from athletes to people with disabilities. Because it is low impact and can be done lying, sitting, or standing, "qigong  is accessible for people with disabilities, seniors, and people recovering from injuries. Therapeutic use. Therapeutic use of qigong" is directed by TCM, CAM, integrative medicine, and other health practitioners. In China, where it is considered a "standard medical technique", "qigong" is commonly prescribed to treat a wide variety of conditions, and clinical applications include hypertension, coronary artery disease, peptic ulcers, chronic liver diseases, diabetes mellitus, obesity, menopause syndrome, chronic fatigue syndrome, insomnia, tumors and cancer, lower back and leg pain, cervical spondylosis, and myopia. Outside China "qigong" is used in integrative medicine to complement or supplement accepted medical treatments, including  for relaxation, fitness, rehabilitation, and treatment of specific conditions. However, there is no high-quality evidence that "qigong" is actually effective for these conditions. Based on systematic reviews of clinical research, there is insufficient evidence for the effectiveness of using "qigong" as a therapy for any medical condition. Safety and cost. "Qigong" is generally viewed as safe. No adverse effects have been observed in clinical trials, such that "qigong" is considered safe for use across diverse populations. Cost for self-care is minimal, and cost efficiencies are high for group delivered care. Typically the cautions associated with "qigong" are the  same as those associated with any physical activity, including risk of muscle strains or sprains, advisability of stretching to prevent injury, general safety for use alongside conventional medical treatments, and consulting with a physician when combining with conventional treatment. Clinical research. Overview. Although there is ongoing clinical research examining the potential health effects of "qigong", there is little financial or medical incentive to support high-quality research, and still only a limited number of studies meet accepted medical and scientific standards of randomized controlled trials (RCTs). Clinical research concerning "qigong" has been conducted for a wide range of medical conditions , including bone density, cardiopulmonary effects, physical function, falls and related risk factors, quality of life, immune function, inflammation, hypertension, pain, and cancer treatment. Systematic reviews. A 2009 systematic review on the effect of "qigong" exercises on reducing pain concluded that "the existing trial evidence is not convincing enough to suggest that internal qigong is an effective modality for pain management." A 2010 systematic review of the effect of "qigong" exercises on cancer treatment concluded "the effectiveness of qigong in cancer care is not yet supported by the evidence from rigorous clinical trials." A separate systematic review that looked at the  effects of qigong exercises on various physiological or psychological outcomes found that the available studies were poorly designed, with a high risk of bias in the results. Therefore, the authors concluded, "Due to limited number of RCTs in the field and methodological problems and high risk of bias in the included studies, it is still too early to reach a conclusion about the efficacy and the effectiveness of qigong exercise as a form of health practice adopted by the cancer patients during their curative, palliative, and rehabilitative phases of the cancer journey." A 2011 overview of systematic reviews of controlled  clinical trials, Lee et al. concluded that "the effectiveness of qigong is based mostly on poor quality research" and "therefore, it would be unwise to draw firm conclusions at this stage." Although a 2010 comprehensive literature review found 77 peer-reviewed RCTs, Lee et al.'s overview of systematic reviews as to particular health conditions found problems like sample size, lack of proper control groups, with lack of blinding associated with high risk of bias. A 2015 systematic review of the effect of "qigong" exercises on cardiovascular diseases and hypertension found no conclusive evidence for effect. Also in 2015, a  systemic review into the effects on hypertension suggested that it may be effective, but that the evidence was not conclusive because of the poor quality of the trials it included, and advised more rigorous research in the future. Another 2015 systematic review of "qigong" on biomarkers of cardiovascular disease concluded that some trials showed favorable effects, but concludes, "Most of the trials included in this review are likely to be at high risk of bias, so we have very low confidence in the validity of the results. Mental health. Many claims have been made that "qigong" can benefit or ameliorate  mental health conditions, including improved mood, decreased stress reaction, and decreased anxiety and depression. Most medical studies have only examined psychological factors as secondary goals, although various studies have shown decreases in cortisol levels, a chemical hormone produced by the body in response to stress. China. Basic and clinical research in China during the 1980s was mostly descriptive, and few results were reported in peer-reviewed English-language journals. "Qigong" became known outside China in the 1990s, and clinical randomized controlled trials investigating the effectiveness of "qigong" on health and mental conditions began to be published worldwide, along with systematic  reviews. Challenges. Most existing clinical trials have small sample sizes and many have inadequate controls. Of particular concern is the impracticality of double blinding using appropriate sham treatments, and the difficulty of placebo control, such that benefits often cannot be distinguished from the placebo effect. Also of concern is the choice of which "qigong" form to use and how to standardize the treatment or amount with respect to the skill of the practitioner leading or administering treatment, the tradition of individualization of treatments, and the treatment length, intensity, and frequency. Meditation and self-cultivation applications. "Qigong" is practiced for  meditation and self-cultivation as part of various philosophical and spiritual traditions. As meditation, "qigong" is a means to still the mind and enter a state of consciousness that brings serenity, clarity, and bliss. Many practitioners find "qigong", with its gentle focused movement, to be more accessible than seated meditation. "Qigong" for self-cultivation can be classified in terms of traditional Chinese philosophy: Daoist, Buddhist, and Confucian. Martial arts applications. The practice of "qigong" is an important component in both internal and external style Chinese martial arts. Focus on "qi" is considered to be a source of power as well  as the foundation of the internal style of martial arts (Neijia). T'ai Chi Ch'uan, Xing Yi Quan, and Baguazhang are representative of the types of Chinese martial arts that rely on the concept of "qi" as the foundation. Extraordinary feats of martial arts prowess, such as the ability to withstand heavy strikes (Iron Shirt, ) and the ability to break hard objects (Iron Palm, ) are abilities attributed to "qigong" training. T'ai Chi Ch'uan and "qigong". "T'ai Chi Ch'uan" (Taijiquan) is a widely practiced Chinese internal martial style based on the theory of taiji, closely associated with "qigong", and typically involving more  complex choreographed movement coordinated with breath, done slowly for health and training, or quickly for self-defense. Many scholars consider t'ai chi ch'uan to be a type of "qigong", traced back to an origin in the seventeenth century. In modern practice, "qigong" typically focuses more on health and meditation rather than martial applications, and plays an important role in training for t'ai chi ch'uan, in particular used to build strength, develop breath control, and increase vitality ("life energy").