Qi Gong is one modality of traditional Chinese medicine (TCM) believed to be at least 4,000 years-old. Written records referring to Qi and its effects are thought to be as old as 3,300 years (Shang dynasty oracle bones, Zhou dynasty inscriptions).
(Source: Natural Medicine Journal)
CLINICAL BOTTOM LINE
"Qi Gong is an umbrella term that subsumes a variety of energy-based healing practices based on Taoist philosophy and principles of Chinese medical theory."
Historical or Theoretical Uses which Lack Sufficient Evidence
Strength of Expert Opinion and Historic/Folkloric Precedent
Brief Safety Summary
DEFINITION AND DESCRIPTION OF TECHNIQUES
Types of Therapies
- Many techniques involve simply holding a prescribed posture, which, when accompanied by meditation, imagery, and breathing techniques, is believed to facilitate the circulation of energy through the meridians and energy centers. The posture may be either standing or sitting. Some methods involve stationary holding of the posture, while others involve prescribed movements. In all cases, the mental intention is to cultivate the circulation of Qi (chi or vital energy) through the practitioner.
- Vocal sounds are used in some techniques. Specific sounds are believed to be associated with specific meridians or organ systems as defined in Taoist medical theory. Vocalization of the sounds (called “the 6 healing sounds”) is believed to aid the circulation of energy through the specific organ networks.
- Bone marrow Qi Gong is a form of internal Qi Gong which comprises specific techniques targeting the circulation of Qi through the bone marrow, to strengthen the blood and immune system.
- One paper qualitatively reviews 2 complementary therapies; Qi Gong and educational kinesiology (EK).5 Authors suggest that Qi Gong and EK may be united through a qualitative convergence and a shared underlying concept. The authors hypothesize that a coherent rationale can be formed through this conceptual synthesis and propose that to some extent Qi Gong movements and EK can be considered to work in unison with each other. The logical synthesis of these 2 therapies is being presented to identify Qi Gong movements with concepts of brain gymnastics and also to explain how this new construct can be developed and implemented into practice. When verified, authors conclude this hypothesis will allow individuals to better understand Chinese health exercises from the modern science perspective such as neuroanatomy, neurophysiology, and psychoneuroimmunology.
Adverse Effects/Post-Market Surveillance
Review of the Evidence: Discussion
Problems in Research
Challenges in Research
Evidence for Specific Medical Conditions
- Ospina et al conducted a review to asses and synthesize the state of research on a variety of meditation practices, including: the specific meditation practices examined; the research designs employed and the conditions and outcomes examined; the efficacy and effectiveness of different meditation practices for the 3 most studied conditions; the role of effect modifiers on outcomes; and the effects of meditation on physiological and neuropsychological outcomes.21 Comprehensive searches were conducted in 17 electronic databases of medical and psychological literature up to September 2005. Other sources of potentially relevant studies included hand searches, reference tracking, contact with experts, and gray literature searches. A Delphi method was used to develop a set of parameters to describe meditation practices. Included studies were comparative, on any meditation practice, had more than 10 adult participants, provided quantitative data on health-related outcomes, and published in English. Two independent reviewers assessed study relevance, extracted the data and assessed the methodological quality of the studies. Five broad categories of meditation practices were identified (mantra meditation, mindfulness meditation, yoga, Tai Chi, and Qi Gong). Characterization of the universal or supplemental components of meditation practices was precluded by the theoretical and terminological heterogeneity among practices. Evidence on the state of research in meditation practices was provided in 813 predominantly poor-quality studies. The 3 most studied conditions were hypertension, other cardiovascular diseases, and substance abuse. Sixty-five intervention studies examined the therapeutic effect of meditation practices for these conditions. Meta-analyses based on low-quality studies and small numbers of hypertensive participants showed that Transcendental Meditation, Qi Gong, and Zen Buddhist meditation significantly reduced blood pressure. Yoga helped reduce stress. Yoga was no better than mindfulness-based stress reduction at reducing anxiety in patients with cardiovascular diseases. No results from substance abuse studies could be combined. The role of effect modifiers in meditation practices has been neglected in the scientific literature. The physiological and neuropsychological effects of meditation practices have been evaluated in 312 poor-quality studies. Meta-analyses of results from 55 studies indicated that some meditation practices produced significant changes in healthy participants. According to the review authors, future research on meditation practices should be more rigorous in the design and execution of studies and in the analysis and reporting of result.
- Cheung et al randomized 88 patients with mild essential hypertension to Guolin Qi Gong or conventional exercise for 16 weeks.22 The main outcome measurements were blood pressure, health status (SF-36 scores), and Beck Anxiety and Depression Inventory scores. In the Qi Gong group, blood pressure decreased significantly from 146.3+/-7.8/93.0+/-4.1 mmHg at baseline to 135.5+/-10.0/87.1+/-7.7 mmHg at week 16. In the exercise group, blood pressure also decreased significantly from 140.9+/-10.9/93.1+/-3.5 mmHg to 129.7+/-11.1/86.0+/-7.0 mmHg. Heart rate, weight, BMI, waist circumference, total cholesterol, renin and 24-hour urinary albumin excretion significantly decreased in both groups after 16 weeks. General health, bodily pain, social functioning, and depression also improved in both groups. No significant differences between Qi Gong and conventional exercise were found. The authors conclude that Guolin Qi Gong and conventional exercise have similar effects on blood pressure in patients with mild hypertension.
- Lee et al randomized 36 adults with hypertension to a Qi Gong group or a wait-listed control group.23 Blood pressures decreased significantly after 8 weeks of Qi Gong, and levels of total cholesterol (TC), high-density lipoprotein (HDL), and Apolipoprotein A1 (APO-A1) were changed significantly in the Qi Gong group post-treatment compared with before treatment. The authors conclude that Qi Gong acts as an antihypertensive and may reduce blood pressure by the modulation of lipid metabolism. However, an inappropriate randomization method was used (assignment based on geographic origin) and dropouts were not described.
- Lee et al randomized 36 adults with hypertension to either a waiting list control or a Qi Gong group that practiced two 30-minute Qi Gong programs per week for 8 consecutive weeks.24 Systolic and diastolic blood pressure was significantly reduced in members of the Qi Gong group after 8 weeks of exercise. Significant improvements in self-efficacy and other cognitive perceptual efficacy variables were also documented in the Qi Gong group compared to controls.
- Lee et al randomized 58 patients with hypertension to either a Qi Gong group (N=29), or a wait list control group (N=29).25 In response to 10 weeks of Qi Gong, systolic blood pressure (SBP), diastolic blood pressure (DBP), and rate pressure product (RPP) were decreased significantly. There was a significant reduction of norepinephrine, epinephrine, cortisol, and stress level in the Qi Gong group. The authors conclude that Qi Gong may reduce blood pressure and catecholamines via stabilizing the sympathetic nervous system.
- Lee et al randomized 58 patients with hypertension to either a Qi Gong group (N=29), or a control group (N=29).26 Systolic blood pressure and diastolic blood pressure decreased significantly in the Qi Gong group such that both became significantly lower after 10 weeks in the Qi Gong than in the control group. Also, there was a significant reduction of norepinephrine, metanephrine, and epinephrine compared to baseline values in the Qi Gong group. The ventilatory functions, forced vital capacity and forced expiratory volume per sec, were increased in the Qi Gong group but not the control. The authors conclude that Qi Gong may stabilize the sympathetic nervous system, is effective in modulating levels of urinary catecholamines and blood pressure positively, and improves ventilatory functions in mildly hypertensive middle-aged patients.
- Li et al studied 45 patients with hypertension who were receiving Traditional Chinese Medicine treatment.27 31 patients also received external Qi Gong treatments while 14 received nifedipine therapy. Plasma 6-K-PGF1 alpha was increased and TXB2 as well as TXB2/6-K-PGF1 alpha ratio were decreased in all subjects (P<0.05). The authors conclude that external Qi Gong therapy helps regulate TXB2 and 6-K-PGF1 alpha in patients with essential hypertension comparable to nifedipine.
- Li et al randomized 61 inpatients with hypertension to Qi Gong group or a Western medicine (WM) group.28 The patients in the Qi Gong group were treated with both Qi Gong and antihypertensive drugs at low dosage, but those in the WM group were treated with the drugs alone. Several laboratory tests concerning sympathetico-adrenomedullary functions were conducted twice respectively at 1st and 9th week after hospitalization of the patients. The results indicated that the Qi Gong group after treatment of 9 weeks had more cases with normal sympathetico-adrenomedullary functions than it had before the treatment, and that their urinary CA, E, and NE decreased; MHPG-SO4 increased; plasma cAMP and cGMP decreased; but cAMP/cGMP ratio increased. The authors suggest that Qi Gong could modulate the sympathetico-adrenomedullary functions of patients with Liver Yang exuberance–type hypertension.
- Wang et al randomized 100 hypertensive patients into a Qi Gong group (Qi Gong with regularly antihypertensive drug taking, N=50) or a control group (with regularly antihypertensive drug taking only, N=50).29 After 1 year of treatment, in the Qi Gong group, the levels of cholesterol (Tc), triglyceride (Tg), LDL-C and AI (AI-Tc-HDL-C/HDL-C) were decreased, while the levels of HDL-C, HDL-C/Tc and HDL-C/LDL-C were significantly increased. In the control group, however, no significant changes were found. The differences between the 2 groups were both were statistically significant (P<0.05–0.001). The authors conclude that practicing internal Qi Gong could elevate serum levels of HDL-C and regulatory metabolism of lipid.
- Wu conducted a case series to evaluate the effects of Qi Gong in 142 patients with essential hypertension (HTN) (137 patients in Stage II).30 Qi Gong therapy consisted of two 30-minute sessions daily for 2 months, and all medications were stopped a week before the therapy. After 2 months of Qi Gong therapy, the average SBP decreased 3.99 kPa, and the DBP decreased 186 kPa. No statistical significance was calculated or mentioned. In the discussion, the authors state that according to TCM theory, HTN is a disease of excess Yang and insufficient Yin. They further comment that cAMP represents Yin, while cGMP represents Yang. From measurements of these 2 parameters, their results suggest that Qi Gong could increase the ratio of cAMP/cGMP, suggesting that it can treat Yin deficiency. Weaknesses of the study included: inclusion of healthy people who did not undergo Qi Gong therapy, and no statistical analyses were done on blood pressure changes. Future study should be a randomized, controlled study using HTN patients rather than healthy patients as control.
- Kuang et al conducted a cohort study of 244 hypertensive patients treated at the Shanghai Hypertension Institute, Shanghai, China, from 1959 to 1964 to determine the effects of Qi Gong.31 A checkup or questionnaire and a regression analysis were done during the follow-up. Patients practicing Qi Gong consistently (using exercises learned at the institute, for the most part in sitting position for 20-30 minutes, but no further details provided) were found to have a lower mortality due to heart attack, kidney, and brain complication (13.9%) as compared to the control group who did not practice Qi Gong (27.9%)(P<0.01). Morbidity due to stroke was also lower for the Qi Gong group (18.0% as compared to 41.0% for the control)(P<0.01). These data suggest that Qi Gong may serve in the prevention of stroke in hypertensive patients.
- Qi Gong relaxation exercise was used for treatment of pregnancy-induced hypertension (PIH).32 Patients exercised 3 times a day until labor. There were 2 groups with 60 cases of PIH who delivered in each group: the treatment group used Qi Gong, and the control group used medicine. The clinical efficacy was evaluated according to PIH combined scores and showed effective for 54 cases (90.0%) in the Qi Gong group and 33 cases (55.0%) in the control group (P<0.01). Meconium stain in amniotic fluid was present in 12 cases (20.0%) in the Qi Gong group and 29 cases (48.3%) in the control group (P<0.05). The incidence of abnormal hematocrit (>35%) before treatment was 52.4% and decreased to 23.8% (P<0.05) in the Qi Gong group, while in the control group it was 35.7% before treatment and 45.2% after treatment (P> 0.05). The mean value of blood E2 by RIA showed increased from 22.97 +/- 13.16 mcg/ml to 33.74 +/- 34.01 mcg/ml after Qi Gong treatment in 29 cases. The microscopical observation of fingernail capillaries showed various degrees of improvement of micro-circulation after Qi Gong exercise for 17 cases and after a course of Qi Gong treatment for 11 cases in the Qi Gong group. For the control group, there were no changes after sitting still for some time.
- Stenlund et al randomized 95 patients (66 men and 29 women) with documented coronary artery disease to an intervention group of group discussion and Qi Gong practice (N=48), mean age 77+/-3 (73–82), or to a usual care control group (N=47), mean age 78+/-3 (73–84).33 The intervention groups met weekly for 3 months. Physical ability was assessed at baseline and after the intervention. Patients in the intervention group increased their self-estimated level of physical activity (P=0.011), their performance in the one-leg stance test for the right leg (P=0.029), coordination (P=0.021), and the box-climbing test for right leg (P=0.035). The authors conclude that a combination of Qi Gong and group discussions appear to be a promising rehabilitation for elderly cardiac patients in terms of improving self-reported physical activity, balance and coordination. However, the effects of Qi Gong and the group experience were not separated out, making conclusions about Qi Gong impossible. Randomization was not described but dropouts were explained.
- Pippa et al conducted a randomized, controlled trial to evaluate the effects of 16 weeks of a medically assisted Qi Gong training program on the physical rehabilitation of patients with stable chronic atrial fibrillation and preserved left ventricular function.34 Researchers conducted the trial because evidence indicates that low energy expenditure protocols derived from traditional Chinese medicine may benefit patients with cardiac impairment. Thirty men and 13 women (mean age 68+/-8 years) were randomized to Qi Gong or to a waitlist control group. Qi Gong training was well-tolerated, and, compared to baseline, trained patients walked an average 114 meters more (27%) at the end of treatment (P<0.001) and 57 meters more (13.7%) 16 weeks later (P=0.008). Control subjects showed no variation in functional capacity. These results seem promising and deserve confirmation with further research.
- Hui et al conducted a clinical trial to evaluate 2 behavioral programs, Qi Gong versus progressive relaxation, in improving the quality of life in cardiac patients.35 Chinese patients ages 42 to 76, with a mean age of 65, were recruited for the study. All 65 patients were diagnosed with cardiac diseases, including ischemic heart disease, myocardial infarct, postcoronary intervention, and valve replacement. All patients were medically stable to undergo phase II cardiac rehabilitation and were cognitively intact and able to follow instructions. Patients were excluded if they had motor impairments or psychiatric disorders that prevented them from participating in Qi Gong or relaxation exercises. There were no significant differences in the demographic and social background between the 2 treatment groups, as determined by chi-squared analysis. Patients were trained in one of 2 practices: progressive relaxation (developed by Yung in 1996) or Qi Gong (based on the methods of Master Lam Ching). A total of 8 sessions (20 minutes each) were conducted. Fifty-nine patients completed all 8 sessions. Six subjects stopped treatments, mostly by the second session; 2 dropouts were admitted to the hospital, and 4 cited financial reasons and discontinued treatment. Blood pressure, heart rate, and psychological questionnaires were taken and compared to baseline measures. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) was taken using an automated monitor. The psychological and quality of life (QoL) assessment was performed using Chinese versions of Short Form 36 (C-SF-36), State-Trait Anxiety Inventory (C-STAI), and General Health Questionnaire (C-GHQ-12). The C-SF-36 measured the following domains of health: physical function (PF), role disruption caused by physical difficulties (RP) or emotional difficulties (RE), social functioning (SF), mental health (MH), and vitality (V). The C-STAI measured state or trait anxiety and was sensitive to improvements in cardiovascular condition after treatment or cardiac surgery. The C-GHQ-12 assessed the general psychological status of the individual. At the end of treatment, patients who practiced progressive relaxation had significantly lower BPs than those who practiced Qi Gong (SBP, P=0.028; DBP, P=0.006). There was no significant difference in most of the psychological parameters in SF-36 except role emotion (RE), in which the Qi Gong group scored significantly higher (P=0.027). End-of-treatment measures for the progressive relaxation group showed significant reductions in SBP (P=0.000) and DBP (P=0.024). Improvements were also seen in state anxiety (P=0.010), trait anxiety (P=0.003), and GHQ-12 (P=0.001). In the Qi Gong group, only SBP was lowered (P=0.013). Similar improvements in state anxiety (P=0.000), trait anxiety (P=0.000), and GHQ were shown in the Qi Gong group when compared to the relaxation group. However, the Qi Gong group showed more improvements in SF-36, with 7 of 8 domains showing significant improvement: PF (P=0.000), RP (P=0.005), GH (P=0.001), V (P=0.006), SF (P=0.001), RE (P=0.003), and MH (P=0.003). Limitations of this study included lack of randomization and lack of a no-treatment control group. Furthermore, the methods used for statistical analysis were not described, and P values of 0.000 were reported incorrectly.
- Omura and Beckman describe various methods of improving circulation and enhancing drug uptake that were used in treating some intractable medical problems caused by infections, and 2 syndromes based on the coexistence of Chlamydia trachomatis infection (mixed with either Lyme Borrelia burgdorferi or Cytomegalovirus) with increased uric acid.36 The principal author's previous studies have indicated that there are 2 opposite types of Qi Gong energy: positive (+) and negative (-). (+) Qi Gong energy has been used clinically to enhance circulation and drug uptake in diseased areas where there is a microcirculatory disturbance and drug uptake is markedly diminished. (-) Qi Gong energy has completely the opposite effect and therefore has not been used, although there may be some as yet undiscovered application. Since the late 1980s the principal author has succeeded in storing (+) Qi Gong energy on a variety of substances including small sheets of paper, and recently has been able to intensify this energy by concentrating it as it passes through a cone-shaped, tapered glass or plastic object placed directly on the (+) Qi Gong energy stored paper. Application of (+) Qi Gong energy stored paper on the cardiovascular representation area of the medulla oblongata at the occipital area of the skull often improved circulation and enhanced drug uptake. If the drug-uptake enhancement was still not sufficient for the drug to reach therapeutic levels in the diseased organ, direct application of (+) Qi Gong from the practitioner's hand often enhanced the drug uptake more significantly. However, this direct method often results in the practitioner developing intestinal microhemorrhage within 24 hours, which may or may not be noticed as mild intestinal discomfort with soft, slightly tarry stool. For intensifying (+) Qi Gong energy, one of the most efficient shapes is a cone with increased intensification occurring at an optimal height. However when the total mass and the total distance from base to peak are increased beyond an optimal limit, the power decreases. Clinical application of Intensified (+) Qi Gong stored energy was evaluated in this preliminary study, which indicated that intensified (+) Qi Gong energy application on the heart representation area of the middle finger on the hands markedly improved circulation in the corresponding organ and increased drug uptake and acetylcholine even more effectively than some of the previously used drug enhancement methods (Shiatsu massage of the organ representation areas and/or application of (+) Qi Gong energy stored paper to the occipital area above the cardiovascular representation area of the medulla oblongata).
Quality of life
- A great number of clinical studies merging traditional Chinese medicine (TCM) and Western medicine have proved the complementary healing effects of Qi Gong in medical science.37 Traditional Chinese respiration exercises help regulate the mind, body, and breathing and coordinate the internal organs, remove toxins, and enhance immunity. Domestic and foreign studies indicate that Qi Gong can relieve chronic pain, reduce tension, increase activities of phagocytes in coenocytes, improve cardiopulmonary function, improve eyesight, and influence the index of blood biochemistry. Due to the obvious healing effects of Qi Gong therapy, through introducing Qi Gong concepts and related medical research, this paper aims to inspire healthcare workers to integrate Qi Gong therapy into medical treatments and nursing care, or to carry out further studies in order to make good the shortfall in provision of holistic medicine and nursing in the interests of the quality of patient care.
- TCM employs methods of treatment such as acupuncture, acupressure, and Qi Gong (treatment based on meditation).38 The nurse using TCM can affect rehabilitation patient outcomes positively. With TCM training, nurses have an opportunity to learn the nuances of the Oriental environment and integrate them into their skills to nurse the spirit, mind, and body of patients in a holistic manner.
- Energy medicine techniques derive from traditional Chinese medicine and are based on the concept that health and healing are dependent upon a balance of vital energy, a still mind, and controlled emotions.39 Physical dysfunctions result from longstanding disordered patterns of energy, and reversal of the physical problem requires a return to balanced and ordered energy. Qi Gong is a system that teaches an individual to live in a state of energy balance. Shen Qi is a sophisticated form of Qi Gong that relies on no external physical interventions but rather relies on mind control to prevent illness, heal existing physical and emotional problems, and promote health and happiness. This paper describes the use of these techniques with people who have long-term physical disabilities.
- Linder et al conducted a randomized controlled trial to assess the ability of Qi Gong to relieve stress.40
1 Ospina MB, Bond K, Karkhaneh M, et al. Meditation practices for health: state of the research. Evid Rep Technol Assess (Full Rep). 2007;(155):1-263.
2 Omura Y, Losco M, Omura AK, et al. Common factors contributing to intractable pain and medical problems with insufficient drug uptake in areas to be treated, and their pathogenesis and treatment: part 1. combined use of medication with acupunture, (+) qi gong energy-stored material, soft laser or electrical stimulation. Acupuncture & Electro-Therapeutics Res Int J. 1992;17(2a):107-148.
3 Kuijpers HJ, van der Heijden FM, Tuinier S, Verhoeven WM. Meditation-induced psychosis. Psychopathology. 2007;40(6):461-464.
4 Jonas W, Levin J. Essentials of Complementary and Alternative Medicine. Philadelphia: Lippincott Williams & Wilkins, 1999.
5 Posadzki P, Parekh S, O’Driscoll ML, Mucha D. Qi Gong’s relationship to educational kinesiology: A qualitative approach. J Bodyw Mov Ther. 2010;14(1):73-79.
6 Ryu H, Mo HY, Mo GD, et al. Delayed cutaneous hypersensitivity reactions in Qigong (chun do sun bup) trainees by multitest cell mediated immunity. Am J Chin Med. 1995;23(2):139-144.
7 Lim RF, Lin KM. Cultural formulation of psychiatric diagnosis. Case no. 03. Psychosis following Qi-gong in a Chinese immigrant. Cult Med Psychiatry. 1996;20(3):369-378.
8 Hwang WC. Qi-gong psychotic reaction in a Chinese American woman. Cult Med Psychiatry. 2007;31(4):547-560.
9 Shan HH. Culture-bound psychiatric disorders associated with qigong practice in China. Hong Kong J Psychiatry. 2000;10(3):12-14.
11 Lim RF, Lin KM. Cultural formulation of psychiatric diagnosis. Case no. 03. Psychosis following Qi-gong in a Chinese immigrant. Cult Med Psychiatry. 1996;20(3):369-378.
12 Kuijpers HJ, van der Heijden FM, Tuinier S, Verhoeven WM. Meditation-induced psychosis. Psychopathology. 2007;40(6):461-464.
14 Shan HH. [Abnormal psychiatric state of qi-gong deviation]. Zhong Xi Yi Jie He Za Zhi. 1988;8(12):717-718.
15 Kuijpers HJ, van der Heijden FM, Tuinier S, Verhoeven WM. Meditation-induced psychosis. Psychopathology. 2007;40(6):461-464.
16 Zhou MR, Lian MR. [Observation of qi-gong treatment in 60 cases of pregnancy-induced hypertension]. Zhong Xi Yi Jie He Za Zhi. 1989;9(1):16-25.
17 Wu WH, Bandilla E, Ciccone DS, et al. Effects of qigong on late-stage complex regional pain syndrome. Altern Ther Health Med. 1999;5(1):45-54.
18 Loh SH. Qigong therapy in the treatment of metastatic colon cancer. Altern Ther Health Med. 1999;5(4):111-112.
19 Reuther I, Aldridge D. Qigong Yangsheng as a complementary therapy in the management of asthma: a single-case appraisal. J Altern Complement Med. 1998;4(2):173-183.
21 Ospina MB, Bond K, Karkhaneh M, et al. Meditation practices for health: state of the research. Evid Rep Technol Assess (Full Rep). 2007;(155):1-263.
22 Cheung BM, Lo JL, Fong DY, Chan MY, et al. Randomised controlled trial of qigong in the treatment of mild essential hypertension. J Hum Hypertens. 2005;19(9):697-704.
23 Lee MS, Lee MS, Kim HJ, Choi ES. Effects of qigong on blood pressure, high-density lipoprotein cholesterol and other lipid levels in essential hypertension patients. Int J Neurosci. 2004;114(7):777-786.
24 Lee MS, Lim HJ, Lee MS. Impact of qigong exercise on self-efficacy and other cognitive perceptual variables in patients with essential hypertension. J Altern Complement Med. 2004;10(4):675-680.
25 Lee MS, Lee MS, Kim HJ, Moon SR. Qigong reduced blood pressure and catecholamine levels of patients with essential hypertension. Int J Neurosci. 2003;113(12):1691-1701.
26 Lee MS, Lee MS, Choi ES, Chung HT. Effects of Qigong on blood pressure, blood pressure determinants and ventilatory function in middle-aged patients with essential hypertension. Am J Chin Med. 2003;31(3):489-497.
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28 Li W, Xin Z, Pi D. [Effect of qigong on sympathetico-adrenomedullary function in patients with liver yang exuberance hypertension]. Zhong Xi Yi Jie He Za Zhi. 1990;10(5):261, 283-285.
29 Wang CX, Xu DH. [Influence of qigong therapy upon serum HDL-C in hypertensive patients]. Zhong Xi Yi Jie He Za Zhi. 1989;9(9):516, 543-544.
30 Wu Y, Wei L, and Deren P. [Laboratory study of qigong therapy for patients with essential hypertension]. Bulletin of Hunan Medical University. 1993;18(3):269-271.
31 Kuang AK, Wang CX, Zhao GS, et al. Long-term observation on qigong in prevention of stroke—follow-up of 244 hypertensive patients for 18-22 years. J Tradit Chin Med. 1986;6(4):235-238.
32 Zhou MR, Lian MR. [Observation of qi-gong treatment in 60 cases of pregnancy-induced hypertension]. Zhong Xi Yi Jie He Za Zhi. 1989;9(1):16-25.
33 Stenlund T, Lindstrom B, Granlund M, Burell G. Cardiac rehabilitation for the elderly: Qi Gong and group discussions. Eur J Cardiovasc Prev Rehabil. 2005;12(1):5-11.
34 Pippa L, Manzoli L, Corti I, Congedo G, Romanazzi L, Parruti G. Functional capacity after traditional Chinese medicine (qi gong) training in patients with chronic atrial fibrillation: a randomized controlled trial. Prev Cardiol. 2007;10(1):22-25.
35 Hui PN, Wan M, Chan WK, Yung PM. An evaluation of two behavioral rehabilitation programs, qigong versus progressive relaxation, in improving the quality of life in cardiac patients. J Altern Complement Med. 2006;12(4):373-378.
36 Omura Y, Beckman SL. Application of intensified (+) Qi Gong energy, (-) electrical field, (S) magnetic field, electrical pulses (1-2 pulses/sec), strong Shiatsu massage or acupuncture on the accurate organ representation areas of the hands to improve circulation and enhance drug uptake in pathological organs: clinical applications with special emphasis on the “Chlamydia-(Lyme)-uric acid syndrome” and “Chlamydia-(cytomegalovirus)- uric acid syndrome”. Acupunct Electrother Res. 1995;20(1):21-72.
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38 Sherwin DC. Traditional Chinese medicine in rehabilitation nursing practice. Rehabil Nurs. 1992;17(5):253-255.
39 Trieschmann RB. Energy medicine for long-term disabilities. Disabil Rehabil. 1999;21(5-6):269-276.
40 Linder K, Svardsudd K. [Qigong has a relieving effect on stress]. Lakartidningen. 2006;103(24-25):1942-1945.