Qigong in mental healthcare

2. Qigong in mental healthcare Colorado Integrative Medicine Conference July, 2009 James Lake M.D. www.IntegrativeMentalHealth.net

3. Qigong in mental health care • 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

4. Qigong What it is and where it came from

5. 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

6. 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 20thcentury

7. 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

8. 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”

9. 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”)

10. How qigong works • Qigong exercises strengthen one or more dantien or convert one energetic principle into another where deficiency or imbalance exists • The three dantien (“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 dantien

11. 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

12. 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

13. 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

14. 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 explainbeneficial health effects of qigong

16. Medical qigong First principles

17. 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

18. 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” (weiqi) emanates from all living things • Internal stresses (psychological traits, strong emotions) and external “stresses” (disease-causing organisms, toxic substances) damage protective field resulting in illness

19. Wei qi • Disruption of weiqi 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 self-directed qigong practice or emission qigong Rx replenishes or re-balances qi energetic patterns, restoring weiqi

20. 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

22. Qigong and mental health Energy and balance

23. 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

24. 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

25. Qigong in mental health—concepts • Yuan Shen is innate or “inherited” spiritual pattern of the individual and connection to divine energy of the universe • ZhiShen corresponds to beneficial or toxic thought patterns acquired following birth • Yuan Shen resides in the brain, while the ZhiShen resides in the heart

26. Qigong in mental health—concepts • Yuan Shen (mind) rules over the ZhiShen (heart) • Imbalances of Yuan Shen and ZhiShen manifest as different psychological or emotional symptoms • Work of the qigong master or qigong practice is to correct imbalances through appropriate qigong exercises

27. 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

28. 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

30. Medical qigong research Competing theoretical perspectives

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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”

37. 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

38. 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 self-selected and do not share values or beliefs that improve outcomes

39. 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)

40. 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)

41. 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

42. 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

43. 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

44. 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

46. Safety Precautions and contra-indications

47. Safety • No studies assessing long term safety issues or contra-indications • Review of literature from both English and Chinese language sources revealed no absolutecontraindications of qigong practice or external qigong Rx

48. 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

49. 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

50. 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