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Integrating Qigong into Healthcare!
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Integrating Qigong into Healthcare
Adding!Qigong!Health!Care!to!the!Healthcare!System!
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By!Tom!Rogers!and!Josie!Weaver!
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The!American!healthcare!industry!is!in!a!challenged!state!because!it!is!an!expensive!system!focused!on!
financing!medical!intervention!for!treating!disease!after!people!are!sick!and!not!on!safety,!cost!
effectiveness,!prevention,!and!actual!health!care(2*0"4*!people!get!sick.!The!pandemic!crisis!with!
COVID-19!has!exposed!the!need!for!personal!and!public!health-care!practices!to!enhance!immunity!and!
resilience.!The!nation!has!an!opportunity!to!reimagine!health!care.!Scientific!research!proves!that!
Qigong!is!a!non-invasive!self-care!practice!that!provides!physical!and!emotional!well-being!and!resilience!
that!can!be!clinically!measured.!Qigong!exercise!results!in!the!active!creation!of!health!and!is!a!useful!
health!intervention!that!could!be!more!fully!integrated!into!American!healthcare.(
Creating Health with Qigong
Among!the!behaviors!that!create!health,!“exercise!as!medicine”!is!a!global!health!initiative!put!forth!by!
the!American!College!of!Sports!Medicine!with!the!aim!of!getting!primary!care!physicians!and!other!
health-care!providers!to!include!exercise!in!treatment!plans!for!patients.!Patient!action!is!an!essential!
means!to!and!component!of!this!patient-centered!health.!Patients!are!not!merely!consumers!of!health!
care!dispensed!by!physicians!or!professionals!but!are!producers!and!creators!of!health.!!Removing!
barriers!to!the!self-care!practice!of!Qigong!is!a!way!to!remove!barriers!to!patient!action.!One!of!the!
great!misconceptions!in!our!society!is!that!medicine!only!comes!from!outside!of!ourselves.!The!Chinese!
healthcare!model!says!that!the!free!inner!medicine!comes!from!within!us!and!is!available!to!anyone.!
Qigong!practice!includes!biomedical,!social,!and!psychological!aspects!of!health!that!are!described!by!
institutions!such!as!the!U.S.!Veteran’s!Administration!as!“whole!person!health,”!and!are!delivered!by!a!
biopsychosocial!model!of!medicine.!Biopsychosocial!medical!practices!and!therapies!integrate!
physiological,!cognitive,!emotional,!and!social!input!with!neurophysiological!mechanisms!(Wade!2017).!
The!scientific!evidence!for!Qigong!as!a!biopsychosocial!“whole!person”!health!modality!is!not!well!
known!or!understood!which!creates!a!situation!where!efforts!at!certification!and!legislation!are!not!
being!informed!by!science.!!Understanding!scientific!research!on!Qigong!is!required!to!keep!these!
efforts!from!creating!unnecessary!barriers!to!its!dissemination.!!
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Qigong and Tai Chi as Meditative Movement Exercise
Jahnke!described!the!fundamental!practices!of!Qigong!using!Western!medical!terms!in!!/*(C*$3*4(
D+./+-!(Jahnke,!1997),!but!the!first!effort!to!define!or!standardize!the!fundamentals!of!Qigong!and!Tai!
Chi!occurred!at!the!National!Expert!Meeting!on!Qi!Gong!and!Tai!Chi.!Two!very!important!outcomes!of!
the!meeting!were!identifying!a!set!of!fundamental!practices!common!to!both!Qigong!and!Tai!Chi!and!
declaring!that!Tai!Chi!practiced!for!health!and!Qigong!are!equivalent!(Chodzko-Zajko!and!Jahnke!2005).!
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This!equivalence!was!introduced!to!clinical!research!with!the!definition!of!a!new!category!of!exercise!
called!Meditative!Movement!(MM),!separate!from!traditional!forms!of!exercise!because!it!includes!
Qigong!and!Tai!Chi,!which!has!the!following!characteristics:!!“(a)!some!form!of!movement!or!body!
positioning,!(b)!a!focus!on!breathing,!and!(c)!a!cleared!or!calm!state!of!mind!with!a!goal!of!(d)!deep!
states!of!relaxation”!(Larkey!2009).!Researchers!have!used!the!term!MM,!or!equivalent!terms,!including!
“movement!with!attentional!focus”!(Payne!2013),!“movement-based!embodied!contemplative!
practices”!(Schmalzl!2014),!and!“mindfulness-based!movement”!(Lucas!2018),!each!with!discussion!
about!the!roles!of!movement,!posture,!breathing,!interoception,!kinesthesis,!and!emotional!and!social!
regulation.!The!equivalency!of!many!different!forms!of!MM!exercise!can!be!established!not!only!on!the!
level!of!energy!output!generated!in!the!activity,!but!also!on!the!underlying!similarity!in!observable!
mechanisms!of!action!and!related!outcomes!and!health!benefits!(Jahnke!2010).!As!MM,!Qigong!and!Tai!
Chi!can!thus!be!considered!functionally!equivalent.!The!importance!of!the!equivalence!of!Tai!Chi!
practiced!for!health!and!Qigong!cannot!be!overstated!because!it!is!the!intersection!of!the!exercises!that!
are!the!easiest!to!practice!and!teach,!and!they!provide!the!most!benefit.!The!National!Expert!Meeting!
concluded!that!“there!is!growing!evidence!that!Qigong!and!Tai!Chi!practices!may!be!among!the!best!
forms!of!physical!activity!for!diverse!populations!because!they!are!low!impact,!low!cost!and!easy!to!
learn”!(Chodzko-Zajko!and!Jahnke!2005).!Given!the!above!equivalence,!we!refer!to!Qigong!as!including!
Tai!Chi!unless!otherwise!noted.!!
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Scientific Research on Qigong
Western!medical!awareness!of!the!benefits!of!Qigong!began!with!the!introduction!of!Traditional!Chinese!
Medicine!(TCM)!practices!to!the!West!in!the!1970’s,!but!it!was!Deng!Xiaoping’s!modernization!reforms!
in!the!1980’s!that!led!to!the!first!large-scale!Western-style!medical!research!on!Qigong!in!China.!The!first!
Western!medical!systematic!review!of!the!benefits!of!Qigong!and!Tai!Chi!found!improved!bone!density,!
cardiopulmonary!effects,!physical!function,!quality!of!life,!self-efficacy,!patient!reported!outcomes,!
psychological!symptoms,!and!immune!function;!and!reduced!psychological!symptoms,!falls,!and!related!
risk!factors!(Jahnke!2010).!Harvard!Medical!School!and!the!Veterans!Administration!have!strongly!
endorsed!Qigong!and!Tai!Chi!for!a!very!broad!range!of!health!conditions!(Wayne!2013,!Hempel!2014,!
Harvard!2019).!Clinical!research!trials!have!shown!Qigong!and/or!Tai!Chi!to!be!effective!interventions!for!
hypertension,!diabetes,!osteoarthritis,!osteoporosis,!breast!cancer,!heart!failure,!COPD,!coronary!heart!
disease,!schizophrenia,!depression,!quality!of!life,!strength,!flexibility,!cardiovascular!function,!balance,!
pulmonary!function,!stress,!mood,!physical!function,!mental!health!and!cognitive!function,!risk!of!falls,!
self-efficacy,!anxiety,!self-esteem,!quality!of!sleep,!and!safety,!cancer!care,!immune!function,!
inflammation,!pain,!arthritic!and!musculoskeletal!conditions,!depression,!fibromyalgia,!Parkinson’s!
Disease,!multiple!sclerosis,!and!stroke!(Yang!2015,!Klein!2017,!van!Dam!2020,!Zhang!2020).!!The!World!
Tai!Chi!and!Qigong!Day!website!lists!one!hundred!common!health!issues!addressed!by!Tai!Chi!or!Qigong!
(Douglas!2021),!and!the!Qigong!Institute’s!Qigong!and!Energy!Medicine!Database™!contains!over!16000!
abstracts,!including!2200!abstracts!on!Qigong!research!and!1500!abstracts!on!Tai!Chi!research!(Qigong!
2021).!
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Clinical Research Protocols Using Qigong
Qigong!and!Tai!Chi!are!complex,!multimodal!interventions!and!practices!that!integrate!many!physical,!
emotional,!cognitive,!social,!and!behavioral!components.!Thus,!researchers!have!employed!various!
methods!to!take!the!complexity!of!the!Qigong!and!Tai!Chi!interventions!into!account.!Research!methods!
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of!randomized!clinical!trials!have!included!specific!traditional!and!recognized!Tai!Chi!and!Qigong!forms,!
simplified!forms,!and!criteria!(e.g.,!years!of!experience)!for!the!Qigong!and!Tai!Chi!teachers!participating!
in!clinical!research!as!practice!leaders.!This!has!amounted!to!using!a!wide!variety!of!protocols!across!
studies!and!in!many!cases!for!research!on!identical!medical!conditions.!A!sampling!of!Qigong!exercises!
used!in!clinical!trials!include!Tai!Chi!Easy™!(Larkey!2015),!Tai!Ji!Quan:!Moving!for!Better!Balance!(Li!
2019),!Tai!Chi!for!Arthritis!(Song!2010),!Tai!Chi!Chih!(Irwin!2017),!Baduanjin!(Zou!2018,!Osypiuk!2020)!
and!Health!Qigong!(Baduanjin,!Wuqinxi,!Yijinjing,!Liuzijue)!(Yu!2020).!
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In!addition!to!different!protocols!being!used!in!different!randomized!controlled!trials!(RCTs)!for!the!
same!clinical!conditions,!different!teachers!have!used!their!own!protocols!in!the!same!RCT!(Yeh!2011).!
The!wide!success!of!different!Qigong!and!Tai!Chi!protocols!for!the!same!condition,!or!the!same!protocol!
for!different!conditions,!reveals!a!pattern!across!studies:!the!teaching!and!practice!of!the!fundamental!
components!of!Qigong,!as!taught!by!many!schools!and!philosophies!of!the!practice,!have!consistently!
yielded!positive!health!outcomes!and!are!repeatable.!
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Fundamental Components of Qigong for Health
SIDEBAR:!Neuromotor!Benefits!of!Qigong!for!Health.!Qigong!is!a!form!of!exercise!that!improves!
cardiovascular,!musculoskeletal,!and!neuromotor!function,!decreases!stress,!and!builds!immunity!and!
resilience.!One!of!the!primary!mechanisms!is!maintaining!neuromotor!fitness.!The!American!College!of!
Sports!Medicine!(ACSM)!recommends!Qigong!in!their!Position!Stand!for!neuromotor!fitness!and!as!
prescribed!exercise!(Huang!2021).!Neuromotor!exercise!training!for!functional!fitness!incorporates!
somatic!motor!skills!such!as!balance,!coordination,!gait,!and!agility,!and!proprioceptive!training.!
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“Multifaceted!physical!activities!such!as!tai!ji!(tai!chi),!qigong,!…!involve!varying!combinations!of!
neuromotor!exercise,!resistance!exercise,!and!flexibility!exercise.!Neuromotor!exercise!training!is!
beneficial!as!part!of!a!comprehensive!exercise!program!for!older!persons,!especially!to!improve!balance,!
agility,!muscle!strength,!and!reduce!the!risk!of!falls”!(Garber!et!al.,!2011)!(Hu!2020).!!
Although!it!can!be!practiced!sitting!or!lying!down,!Qigong!is!predominately!a!movement-based!exercise!
whose!fundamentals!include!meditative!focus!on!breath,!mind,!and!body.!In!addition!to!the!neuromotor!
benefits!of!Qigong!as!a!movement-based!exercise,!research!also!indicates!a!bi-directional!relationship!of!
body!posture!and!exercise!with!mental!states.!The!physical!body!plays!a!strong!causal!role!in!supporting!
cognitive!processes!(Osypiuk,!2018).!This!relationship!becomes!more!apparent!when!breath!and!mind!
focus!are!added!to!the!body!focus.!Advances!in!psychophysiology!and!neuroscience!have!revealed!that!
slow!diaphragmatic!breathing,!interoception,!and!meditative!focus!affect!the!human!system!and!
correspond!to!fundamental!components!of!Qigong.!
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Slow Diaphragmatic Breathing
Physiological!function,!immune!function,!lung!capacity,!behavioral!relaxation,!emotional!regulation,!
suppression!of!chronic!inflammation,!regulation!of!the!stress!response,!and!maximization!of!heart!rate!
variability!are!enhanced!through!slow,!deep!diaphragmatic!breathing.!Diaphragmatic!breathing!is!a!
particularly!effective!way!to!stimulate!the!vagus!nerve!which!is!essential!in!the!regulation!of!metabolic!
homeostasis!and!controlling!immune!function!and!pro-inflammatory!responses!(Pavlov!2012).!
Psychophysiological!research!reveals!that!slow!diaphragmatic!breathing!is!related!to!vagus!nerve!
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stimulation!and!improved!executive!and!cognitive!performance,!social!function,!and!overall!health!
(Laborde!2017).!!
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Diaphragmatic!breathing!modulates!cardiovascular,!respiratory,!and!gastrointestinal!systems!through!
the!Autonomic!Nervous!System!(ANS).!!In!addition!to!real-time!input,!the!current!state!of!the!ANS!is!
based!on!one’s!life!experience!through!engagement!behavior!with!and!feedback!from!the!environment.!
The!ANS!is!a!sub-cortical!and!sub-conscious!detection!system!without!directed!awareness.!The!“fight-or-
flight”!(sympathetic)!and!the!“rest!and!digest”!(parasympathetic)!branches!(i.e.,!states)!of!the!ANS!have!
traditionally!been!presented!as!operating!in!inverse!relation!to!one!another!analogous!to!a!teeter-
totter:!An!increase!in!one!causes!a!corresponding!decrease!in!the!other,!and!vice-versa.!!
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However,!Polyvagal!Theory!defines!a!multi-state!ANS!hierarchy!of!ventral!vagal!(parasympathetic:!
health,!growth,!restoration),!sympathetic!(fight!or!flight!mobilization),!and!dorsal!vagal!
(parasympathetic:!rest!and!digest,!but!also!life-threatening,!dissociation,!immobilization,!and!shutdown)!
(Porges!2009).!This!hierarchical!model!explains!how!people!who!are!in!a!dorsal-vagal!state!can!be!
unavailable!for!social!interaction!(withdrawn!and!dissociated)!and!are!consequently!not!able!to!obtain!
benefit!from!meditation-based!clinical!practices!and!therapy!(Watford!2019).!Polyvagal!Theory!indicates!
that!appropriate!clinical!interventions!for!conditions!such!as!trauma!and!chronic!pain!feature!slow!
diaphragmatic!breathing!(a!key!component!of!Qigong)!to!stimulate!the!vagus!nerve,!which!moves!the!
nervous!system!towards!the!parasympathetic!ventral!vagal!state.!Such!an!intervention!safely!and!
effectively!engages!a!patient’s!ANS!dynamics!to!allow!them!to!take!advantage!of!meditative!practices!as!
part!of!their!therapy!and!healing.!!
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In!addition!to!moving!discretely!between!states,!the!ANS!can!be!in!combined!states!as!well!(Quintana!
2019).!Qigong!practice!stimulates!the!vagus!nerve!(Dedoncker!2021)!and!can!lead!to!a!“Qigong!state”!of!
being!simultaneously!“relaxed!and!alert.”!This!combined!parasympathetic!and!sympathetic!ANS!state!
enhances!action!and!flow,!leading!to!healing,!resilience,!creativity,!innovation,!co-regulation,!and!
adaptability.!Researchers!have!also!uncovered!the!connection!between!vagus!nerve!stimulation!and!
cognitive!processing!(Frangos!2017)!and!have!identified!vagus!nerve!stimulation!as!the!prime!candidate!
in!explaining!the!effects!of!contemplative!practices!on!health,!mental!health,!and!cognition!(Gerritsen!
2018).!The!mental!processes!of!contemplative!practices!depend!on!simultaneous!cognitive!and!
physiological!processing.!This!psychophysiological!(mental!processes!and!physical!stimuli)!combination!is!
a!key!component!of!the!“mind-body”!science!of!Qigong.!
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Meditative Awareness and Interoception
Learning!to!have!present!moment!awareness!of!and!attention!to!the!body!without!distractions!such!as!
thoughts!is!a!mindfulness!skill.!Interoception!is!the!underlying!neurological!mechanism!of!mindfulness-
based!approaches.!Clinical!research!describes!mindfulness!as!the!attentional!focus!necessary!and!
fundamental!for!gaining!interoceptive!skills!(Gibson!2019).!The!refined!ability!to!sustain!awareness!
characterizes!what!in!Qigong!is!called!cultivating!the!skill!of!self-observation!and!regulating!emotional!
responses!to!bodily!sensation.!Interoception!refers!collectively!to!the!processing!of!internal!bodily!
stimuli!by!the!nervous!system!and!includes!physical!responses!in!body!and!brain!representation!such!
that!the!sensing!of!stimuli!is!available!for!reflection,!insight,!conscious!awareness,!and!action.!This!
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characteristic!training!of!awareness!makes!Qigong!an!“interoceptive!awareness!practice.”!Interoception!
is!such!a!new!field!of!psychophysiological!study!that!its!first!international!conference!was!held!in!2016.!!
The!National!Center!for!Complementary!and!Integrative!Health!(NCCIH)!is!focusing!on!the!
multidisciplinary!study!of!interoception!science!as!a!way!to!research!mind-body!practice,!including!
Qigong!(Chen!2020).!!
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Recent!research!findings!highlight!interoception’s!role!in!emotional!experience,!self-regulation,!
physiological!health,!cognition,!behavior,!decision-making,!and!consciousness!(Khalsa!2018,!Quadt!
2018).!As!a!strong!supporter!of!interoceptive!research,!NCCIH!sponsored!the!development!of!a!
subjective!measure!of!interoception!called!the!Multidimensional!Assessment!of!Interoceptive!
Awareness!(MAIA),!which!is!a!32-item!state-trait!questionnaire!to!measure!multiple!dimensions!of!
interoception!by!self-report!(Mehling,!2018).!A!key!element!of!interoception!is!the!concept!of!
interoceptive!accuracy!with!greater!health!being!associated!with!higher!interoceptive!accuracy.!Lower!
interoceptive!accuracy!has!been!associated!with!increased!stress!and!inflammation,!and!interoceptive!
dysfunction!is!emerging!as!an!important!biomarker!for!mental!illness!and!psychological!distress.!
Research!featuring!Qigong!Mind-Body!Exercise!as!the!intervention!showed!improvement!in!MAIA!scores!
and!better!management!of!post-surgical!pain!(Osypiuk!2020).!Interoceptive!awareness!of!one’s!own!
physiological!and!mental!processes!improves!stress!coping;!promotes!adaptive!perspectives!and!
behavioral!responses;!increases!tolerance!of!distress;!improves!self-compassion!and!positive!
expectancies;!and!most!importantly,!incorporates!acceptance!of!uncertainty!into!one’s!life!view.!!
Qigong for Personal and Public Health in America
In!spite!of!overwhelming!scientific!evidence,!the!wide-spread!adoption!of!Qigong!and!its!integration!into!
the!existing!Western!medical!model!of!healthcare!face!challenges.!These!include!the!current!healthcare!
delivery!system,!patient!education!versus!patient!treatment,!insufficient!numbers!of!teachers!and!
instructors!to!teach!the!basics!and!lead!practices,!and!attempts!at!regulation!and!legislation!that!have!
not!been!based!on!science,!common!sense,!or!consensus!of!subject!matter!experts!and!stakeholders.!
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Given!that!70!to!90!percent!of!diseases!are!preventable!(Fries!1993,!DHHS!2000,!DHHS!2010)!and!75!to!
90!percent!of!all!visits!to!primary!care!physicians!are!for!stress!related!problems!(AIS!2020),!the!benefits!
of!adopting!a!stress!reducing!intervention!such!as!Qigong!more!widely!through!personal,!group-based,!
organizational,!and!clinical!practice!cannot!be!overstated.!Although!stress!appears!to!be!the!basis!of!
many!diseases,!stressful!events!or!stressful!somatic!sensory!input!are!not!objectively!"stressful."!Central!
to!stress!management!is!how!an!individual!structures,!perceives,!and!evaluates!their!experience:!
Thoughts!produced!about!an!event!can!put!someone!under!stress!rather!than!the!sensory!input!evoked!
by!injury,!inflammation,!or!other!pathology!(Melzack!2001).!!Changing!people’s!lifestyles!and!
philosophies!of!health!and!healing!through!self-care!and!mind-body!integration!through!practicing!
Qigong!would!have!a!major!impact!on!lowering!societal!healthcare!costs!and!improving!the!healthcare!
system.!
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Embracing a New Definition of Healthcare
For!the!current!American!healthcare!system!to!incorporate!Qigong,!the!adoption!of!an!enhanced!and!
complementary!model!of!healthcare!must!take!effect.!In!general,!Western!medical!practice!treats!
healthcare!and!clinical!therapy!as!a!metaphorical!“fire!extinguisher”!intended!to!be!used!only!for!
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emergencies!versus!disease!prevention,!exercise,!and!wellbeing.!In!the!Western!model!of!healthcare,!
healing!itself!is!a!medical!procedure!that!requires!the!supervision!of!a!medical!team!or!physician.!The!
medicalization!of!health!and!health!care!interventions!such!as!Qigong!presupposes!a!malady!or!
condition!that!must!be!addressed.!The!original!definition!of!medicine!is!that!it!is!an!inner!power!that!can!
be!cultivated.!For!this!reason,!the!National!Qigong!Association!(NQA)!did!not!explicitly!define!“Medical!
Qigong”!in!hard!terms!so!that!practitioners!would!not!use!the!term!“Medical!Qigong”!to!describe!a!
practice!that,!like!a!fire!extinguisher,!is!meant!to!be!used!only!in!emergencies.!In!China,!Qigong!therapy!
is!a!category!of!medical!practice!where!medical!records!are!identical!to!those!in!western!medicine,!but!
the!diagnosis!of!a!condition!involves!both!Chinese!and!Western!categories!of!disease,!and!Qigong!
exercises!may!be!given!as!prescriptions.!In!contrast,!Western!medicine!defines!the!terms!“medical”!and!
“medicine”!as!constituting!a!practice!that!includes!making!a!diagnosis!and!prescribing!particular!
interventions!and!potentially!pharmacological!prescriptions!for!particular!health!conditions.!Since!
Qigong!practice!leaders!and!teachers!are!not!diagnosing!and!prescribing!like!doctors,!Qigong!instructors!
are!not!practicing!medicine!and!therefore!do!not!need!a!license!to!teach!and!share!Qigong!practice!
(Rogers!2019)!(Weaver!2019).!!With!chronic!diseases!now!accounting!for!most!morbidity!in!Western!
countries,!healthcare!systems!designed!around!acute!biomedical!care!models!are!struggling!to!improve!
patient-reported!outcomes!and!reduce!health-care!costs.!Consequently,!a!biopsychosocial!medical!
model!needs!to!be!consistently!applied!to!healthcare!management.!!
!
Patient Education versus Patient Treatment
With!Qigong!the!goal!is!to!widen!the!definition!of!the!terms!“medical”!and!“medicine”!in!order!to!
emphasize!and!include!health,!wellness!and!prevention!as!well!as!intervention.!One!health!care!
practitioner!does!not!take!care!of!all!needs;!multiple!providers!are!common!and!even!necessary.!Self-
care!fits!in!prevention!and!overall!health!management,!and!it!is!a!life-long!skill!that!must!be!practiced!
over!time!in!order!to!maintain!the!benefit.!This!is!an!important!idea!for!the!individual!user!and!the!
teacher!of!Qigong!practice:!Understanding!that!there!is!more!to!learn!and!that!there!are!deeper!and!
deeper!levels!of!practice!to!investigate.!The!important!line!between!education!and!treatment!provides!a!
guide!for!how!hospitals!and!clinics!can!offer!Qigong!as!a!way!of!teaching!health!cultivation!skills.!When!
patients!take!classes,!they!learn!how!to!positively!affect!their!own!body!and!behavior!to!become!active!
participants!in!creating!their!own!health!and!healing.!Qigong!does!not!compete!with!the!allopathic!
approach!and!will!not!replace!it,!but!is!an!effective!complement!to!it,!especially!where!Western!
medicine!is!perceived!as!lacking,!as!in!the!case!of!chronic!conditions!and!comorbidities!for!which!there!
are!no!cure.!As!a!biopsychosocial!practice,!Qigong!provides!a!way!to!give!patients!an!empowering!and!
tangible!exercise!to!bring!a!positive!perspective!and!personal!participation!to!their!healing!and!creation!
of!health.!This!type!of!"take-home"!exercise!is!what!physicians!and!health!care!providers!appreciate!
instead!of!or!in!addition!to!prescribing!medication.!Patients!must!first!get!into!a!state!where!they!can!
heal!and!be!receptive!before!a!therapy!can!become!effective.!And!who!is!qualified!to!help!them!in!this!
task?!!
!
Increasing the Number of Qigong Teachers
Increasing!access!to!Qigong!necessitates!the!demystification!of!Qigong,!such!that!anyone!can!do!the!
fundamental!practices!and!benefit!and!also!teach!others.!Given!the!direct!simplicity!of!the!essentials!of!
Qigong,!the!National!Expert!Meeting!concluded!that!a!practitioner!with!14-16!hours!of!formal!training!
and!time!(six!months)!to!integrate!what!they!learned!can!deliver!effective!Qigong!practice!sessions!
Integrating Qigong into Healthcare!
!
7!
(Chodzko-Zajko!and!Jahnke,!2005).!!Although!the!Experts!acknowledged!the!National!Qigong!
Association’s!(NQA)!professional!level!of!certification!of!200!hours!training,!they!also!defined!the!shorter!
effective!training!levels!of!20!to!50!hours.!Teachers!with!these!shorter!levels!of!training!have!delivered!
Qigong!effectively!in!clinical!research!and!therapy.!The!non-profit!NQA!has!been!certifying!teachers!of!
Qigong!for!over!fifteen!years,!having!done!extensive!groundwork!and!market!research.!The!NQA!levels!
of!certification,!with!the!200-hour!certification!in!particular,!does!not!specify!the!particular!populations!
or!audiences!that!a!certified!teacher!can!teach.!A!teacher!with!a!200-hour!certification!is!qualified!to!
teach!varied!populations.!The!NQA!provides!peer-reviewed!certification!verification!that!validates!
training!as!sound,!meaning!that!the!institution!where!such!a!teacher!trains!has!a!solid!curriculum.!There!
are!also!many!private!schools!and!organizations!that!are!currently!training!teachers!using!curricula!
shorter!than!200!hours!and!successfully!certifying!Qigong!teachers!who!are!effective!teachers!for!a!
range!of!populations.!
!!
However,!the!Experts!also!emphasized!that!continuing!education!is!important!for!lay!leaders!to!improve!
their!skills!and!knowledge!in!areas!such!as!movement,!safety,!principles!of!practice,!and!capacity!to!
tailor!the!presentation!for!specific!populations!whose!limitations!and!experience!can!be!observed!and!
understood!over!time.!The!Experts!also!encouraged!all!practice!leaders!to!keep!up-to-date!with!science!
and!research.!The!experience!and!knowledge!of!teachers!with!more!extensive!training!(e.g.!200!hours!
and!above)!and!numerous!years!of!teaching!experience!are!valuable!in!terms!of!both!refining!teaching!
skills!and!from!working!extensively!with!a!particular!population!(e.g.,!children,!elders,!those!with!chronic!
conditions).!In!addition!to!accumulating!knowledge!of!a!particular!population’s!health!challenges!and!
experience,!such!knowledge!can!lead!to!a!teacher!being!able!to!serve!that!particular!population!well.!
Teachers!with!multiple!years!of!teaching!experience!are!also!likely!to!encounter!wider!or!diverse!
audiences!with!different!levels!of!health!and!ability,!and!this!experience!can!help!refine!a!teacher’s!
presentation!skills.!Most!important,!longevity!as!a!teacher!demonstrates!a!commitment!to!the!
cultivation!of!wellbeing,!and!serves!to!model!this!behavior!for!students!and!increase!an!understanding!
of!creating!health.!!
Qigong Legislation: Stories of Trial and Error
Efforts!at!legislation!threaten!the!dissemination!and!practice!of!Qigong!by!mandating!burdensome!
licensing!laws!that!limit!the!public’s!ability!to!access!teachers!and!therapies!of!their!choice.!Occupational!
licensing!may!restrict!the!supply!of!providers!leading!to!increased!consumer!prices!and!decreased!access!
to!Qigong.!Legislation!often!does!not!make!the!distinction!between!teaching!and!therapy,!thus!further!
restricting!the!supply!of!providers!by!subjecting!teachers!to!therapeutic!standards,!which!often!require!
more!training!and!licensing!fees!and!could!delay!when!a!teacher!can!teach.!Some!bills!require!holistic!
health!care!professionals!to!be!trained!at!state!licensed!schools!in!order!to!obtain!a!license!while!others!
arbitrarily!lump!Qigong!together!with!unrelated!health!practices!such!as!bodywork!and!massage!
therapy.!Worse!still,!proposed!legislation!specifies!detailed!requirements!that!do!not!take!into!account!
existing!evidence-based!science!on!how!Qigong!is!taught,!practiced,!and!incorporated!into!clinical!
therapy!(Rogers!2019,!Weaver!2019).!!
!
There!are!many!recent!and!ongoing!attempts!at!legislating!the!practice!of!Qigong!(NQA!2021).!
Massachusetts!sought!to!define!Qigong!as!“bodywork”!therapy!that!would!license!the!practice!of!using!
touch,!words,!or!directed!movement!to!deepen!awareness!of!patterns!of!movement!in!the!body!or!the!
Integrating Qigong into Healthcare!
!
8!
human!energy!system,!acupoints,!or!Qi!meridians!of!the!human!body.!Under!such!a!law,!anyone!not!
licensed!as!a!massage!therapist!would!not!be!allowed!to!teach!or!practice!$-%!form!of!Qigong.!Due!to!
strong!public!response,!the!bill!was!referred!back!to!committee!for!further!study.!Revised!versions!of!
this!legislation!define!Qigong!as!an!“Asian!bodywork!therapy”!which!is!based!upon!the!body’s!system!of!
energy!(Qi)!(SD1068!2021,!HD1708!2021).!Describing!Qigong!in!terms!of!Qi,!meridians,!and!“energy”!
begs!the!question!of!how!to!define!Qigong!in!terms!Western!medical!professionals,!policy!makers,!and!
the!public!can!actually!understand!and!relate!to.!!
!
6/+-*'*(E*#+,$3(F+:"-:G(the!official!textbook!used!in!colleges!and!universities!of!traditional!Chinese!
medicine!in!China,!clearly!indicates!the!term!“medical!Qigong”!is!not!the!same!thing!as!medical!
treatment!in!the!sense!of!Western!medicine.!By!the!TCM!definition,!a!medical!or!“Clinical!Qigong!
Therapist”!practice!could!include!External!Qi!treatment,!Sound!Resonation!Therapy,!Invisible!Needle!
Therapy,!Tui!Na,!and!Purge,!Tonify,!and!Regulate!practices!in!combination!with!herbal!treatments,!etc.!
(Liu!2010).!!
!
In!addition!to!practicing!Qigong!according!to!the!TCM!definition,!it!can!also!be!practiced!as!“energy!
medicine”!(EM).!Both!Chinese!and!Western!research!have!reported!on!human!bioenergy!and!resonance.!
For!example,!each!cell!in!the!body!can!generate!and!receive!different!forms!of!energy,!including!heat,!
light,!sound,!vibration,!magnetism,!and!electricity.!Allopathic!medicine!uses!a!variety!of!devices!to!
measure,!and!in!some!cases!apply,!forms!of!bioenergy!such!as!transcutaneous!electrical!stimulation,!
magnetic!stimulation,!or!pulsed!electromagnetic!fields!during!therapy.!EM!can!be!human!touch!or!
device-based!and!depends!upon!the!invisible!and!“subtle”!energies!that!form!the!basis!of!“biofield!
therapies”!and!the!field!of!EM!(Ross!2019).!EM!researchers!have!reported!raw!physiological!data!from!a!
range!of!bioenergy!reading!devices!and!suggest!that!these!results!are!indicative!of!practitioner!
competence!and!effectiveness!(Connor!2021).!Scientific!research!has!yet!to!relate!practitioner!bioenergy!
measurements!to!clinical!therapy!outcomes!or!patient!physiology!and!pathology.!In!spite!of!the!limited!
acceptance!and!application!of!EM!through!device-based!and!non-device!treatments!such!as!“qi!
transmission,”!e.g.!Reiki,!therapeutic!touch,!and!“external!Qigong”,!EM!is!perhaps!the!most!
controversial!branch!of!integrative!medicine!because!its!mechanisms!of!action!have!not!been!explained;!
and,!most!important,!the!existence!of!invisible!healing!energy!has!not!been!validated!(Leskowitz!2020).!!
!
A!further!complication!with!treating!Qigong!as!TCM!or!EM!is!that!there!is!no!theory!or!framework!of!
correspondence!between!bioenergy!and!physiology.!Although!the!World!Health!Organization!has!
decided!to!include!TCM!diagnostic!patterns!into!the!new!revision!of!the!International!Classification!of!
Diseases!code!(the!global!standard!for!diagnostic!health!information),!there!is!no!justified!basis!for!the!
existence!of!the!philosophical!concepts!of!Qi,!meridians,!“subtle!energy”,!or!treatments!based!on!them!
from!a!Western!medical!scientific!research!standpoint!(Eigenschink!2020).!This!illustrates!the!need!for!
any!certification!of!Qigong!teachers!and!practitioners,!and!for!any!legislation!that!concerns!Qigong!
teachers!and!practitioners,!to!have!very!clear!and!distinct!definitions!of!Qigong!that!is!practiced!as!MM!
versus!Qigong!practiced!as!TCM!(“clinical!Qigong”)!or!EM.!To!ignore!this!important!distinction!amounts!
to!an!incomplete!definition!of!Qigong!and!does!not!accurately!reflect!how!Qigong!is!taught!and!
practiced.!!
!
Integrating Qigong into Healthcare!
!
9!
Oklahoma!Bill!SB190,!which!was!defeated,!defined!Qigong!over-broadly!as!a!practice!including!a!long!list!
of!TCM!treatment!exercises!and!strictly!prohibited!anyone!from!practicing!any!form!of!Qigong!exercise!
in!a!clinical!situation!unless!properly!licensed!as!a!Clinical!Qigong!Therapist.!A!further!issue!brought!up!in!
this!bill!posed!an!important!question:!Who!is!qualified!to!administer!the!implementation!of!the!law?!
This!bill!specified!the!creation!of!the!Oklahoma!Board!of!Qigong!which!among!a!long!list!of!
administrative!duties!would!enforce!the!legislation!and!determine!tiered!licensing!and!certification!
standards!for!Qigong!teachers,!schools!and!clinical!practitioners!which!would!include!continuing!
education!requirements!as!well!as!professional!conduct!and!ethical!standards.!It!also!included!a!very!
restrictive!requirement!that!no!person!could!represent!themself!as!a!“Qigong!Teacher”!unless!licensed!
in!accordance!with!this!act!which!also!required!a!minimum!of!200!hours!of!training!(Oklahoma!2020).!
!
Illinois!Senate!Bill!SB1930!provides!for!the!licensure!of!Traditional!Asian!Healing!Therapists,!which!
specifically!includes!the!practice!of!Asian!bodywork!therapy,!clinical!Qigong!therapy,!and!Thai!bodywork!
therapy,!by!the!Department!of!Financial!and!Professional!Regulation!(Illinois!2021).!The!bill!defines!the!
minimal!qualifications!for!“clinical!Qigong!therapy”!or!“clinical!Qigong”!to!be!500!hours!of!training!which!
is!the!basic!level!of!Clinical!Qigong!Practitioner!certification!from!the!National!Qigong!Association.!
Clinical!Qigong!Therapy!involves!diagnosis,!treatment,!and!possibly!prescriptions!according!to!Chinese!
medical!principles!and!skills!including!a!wide-range!of!TCM!therapies.!The!scope!of!the!Illinois!bill!
includes!Qi!transmission,!which!as!noted!earlier,!is!problematic!from!a!clinical!research!and!treatment!
standpoint.!Fortunately,!the!proposed!Illinois!legislation!does!not!include!physical!therapy!or!
therapeutic!or!corrective!measures!that!are!outside!of!the!scope!of!Clinical!Qigong!Therapy!as!defined!in!
the!act.!The!proposed!legislation!also!does!not!prohibit!personal!practice!or!instruction!of!Qigong!
outside!of!the!clinic,!nor!does!it!prohibit!teaching!Qigong!as!MM!in!clinical!or!hospital!settings.!!
!
The!state!of!Rhode!Island!has!a!bill!with!similar!requirements!as!the!Illinois!bill!for!regulating!the!
practice!of!acupuncture!and!Oriental!Medicine.!The!Rhode!Island!bill!includes!Qigong!as!one!of!the!
possible!therapies!that!can!be!used!by!those!who!are!licensed!under!the!proposed!law!and!practice!
Chinese!medicine!using!Chinese!medical!diagnostic!methods,!but!it!does!not!attempt!to!otherwise!
regulate!or!restrict!the!teaching!and!practice!of!Qigong!per!se!(Rhode!2021).!
!
Protecting Public Access to Health Care Freedom – Enacting Safe Harbor Legislation
Iowa!Senate!Bill!SF261!mandates!that!providers!of!Alternative!and!Complementary!Medicine!inform!
patients!of!non-state!licensure,!the!nature!of!the!care!they!will!provide,!their!training!and!credentials,!
and!obtain!a!written!acknowledgement!from!the!client!to!be!kept!on!file!for!two!years.!Penalties!are!
associated!with!non-compliance!(Iowa!2019).!But!there!are!no!other!requirements,!so!Qigong!may!be!
taught!anywhere.!
!
Several!states!that!previously!tried!to!legislate!very!problematic!Qigong!regulations!which!were!
defeated!have!switched!to!a!much!more!enlightened!approach!of!passing!Safe!Harbor!Exemption!bills.!
Consumer!access!to!Qigong!and!the!right!to!practice!complementary!and!alternative!health!care!are!
protected!by!Safe!Harbor!practitioner!exemption!laws.!These!laws!allow!Qigong!to!be!freely!available!
without!regulation!in!clinical,!hospital,!or!any!other!settings!(Miller!2019).!Safe!harbor!laws!are!making!
clear!that!access!to!Qigong!is!not!limited!as!long!as!the!practitioner!is!not!directly!assessing!a!person’s!
health,!applying!specific!treatments!or!diagnostic!tests,!or!prescribing!or!administering!specific!
Integrating Qigong into Healthcare!
!
10!
remedies.!SIDEBAR:!Safe!Harbor!Acts.!Safe!Harbor!acts!require!a!signed!acknowledgement!from!the!
client!before!the!practitioner!provides!care!or!treatment!for!the!first!time.!This!disclosure!includes!
practitioner!education!and!training,!contact!and!business!information,!and!state!licensing!status.!The!
safety!factor!is!key!and!the!disclosures!of!experience!and!education/training!requirements!create!the!
necessary!transparency.!Given!the!evidence!base!for!the!safety!of!Qigong!practices,!the!Safe!Harbor!
exemption!is!appropriate!and!also!useful!in!making!the!argument!to!include!the!practices!in!medical!
settings.!This!speaks!to!the!complementary!nature!of!Qigong!practice!and!how!it!works!side-by-side!with!
Western!medicine!and!does!not!replace!it.!Transparency!required!by!law!is!owed!to!the!end!user!in!
return!for!exemption.!But!it!is!the!end-user’s!choice!to!go!ahead!with!it.!
Qigong in Healthcare, Qigong as Therapy
Qigong!and!Tai!Chi!practiced!for!health!have!a!common!foundation!that!provides!basic!health!exercises!
for!illness!prevention,!health!restoration,!enhanced!immune!function,!resilience,!self-healing,!clinical!
treatment,!regulating!mental!and!physical!health,!and!healthy!active!aging.!The!scientific!research!on!
the!fundamental!practices!reveals!how!Qigong!and!Tai!Chi!are!effective!for!both!public!health!and!
therapeutic!intervention.!The!scientific!research!on!Tai!Chi!and!Qigong!also!points!to!the!necessary!
qualifications!of!those!who!teach!in!hospital!settings!or!apply!the!practices!in!clinical!therapy.!
!
The!first!step!in!integrating!Qigong!into!healthcare!involves!personal!practice.!One!of!the!main!barriers!
to!developing!a!personal!practice!is!lack!of!public!education!about!Qigong.!Recognizing!the!cost-
effectiveness!and!health!benefits!of!delivering!Qigong!to!a!huge!population!of!almost!1.4!billion!people,!
the!Chinese!government!is!actively!researching,!promoting,!and!standardizing!the!“traditional!Chinese!
exercises”!of!Qigong!and!Tai!Chi!as!public!health!practices.!The!Chinese!Health!Qigong!Association!is!
actively!promoting!Qigong!by!establishing!affiliated!organizations!in!countries!around!the!world,!
including!the!United!States.!The!United!States!National!Prevention!Strategy!(NPS)!encourages!
partnerships!among!Federal,!state,!tribal,!local,!and!territorial!governments;!business,!industry,!and!
other!private!sector!partners;!philanthropic!organizations;!community!and!faith-based!organizations;!
and!everyday!Americans!to!improve!health!through!prevention!(NPC!2016).!The!main!component!of!
prevention!is!regular!exercise!maintained!throughout!an!individual’s!lifespan.!Qigong!combines!exercise!
with!the!proven!benefits!of!meditation!and!should!be!promoted!to!the!public!as!an!essential!life!skill.!
!
Another!barrier!to!personal!practice!is!lack!of!available!teachers!and!classes.!The!National!Expert!
Meeting!on!Qi!Gong!and!Tai!Chi!defined!program!content!and!structure!for!the!standard!Qigong!
practices!that!are!being!delivered!as!MM!to!students,!teachers,!and!professionals!who!teach!in!
community!centers,!academia,!health!clubs,!YMCA’s,!retreat!centers,!hospitals,!retirement!centers,!
libraries,!the!military,!medical!schools,!schools,!the!justice!system,!and!clinical!settings!as!diverse!as!
cancer!care,!physical!therapy,!and!chronic!pain.!Qigong!practice!for!this!wide!range!of!populations!is!
being!provided!by!people!with!as!few!as!14!-!16!hours!of!training.!Safety!knowledge!and!teaching!skills!
combined!with!basic!Qigong!form!the!foundation!of!this!training!competency!and!the!ability!to!tailor!
programs!for!specific!populations!and!conditions.!This!same!level!of!training!can!be!made!available!to!
physical!therapists,!doctors,!nurses,!and!other!Western!medical!professionals!to!help!bring!Qigong!into!
their!professional!practices.!Thus,!the!medical!care!of!the!patient!is!the!doctor’s!responsibility,!and!the!
doctor!can!recommend!or!declare!Qigong!to!be!a!safe!practice!given!their!patient’s!condition!provided!
they,!as!doctors,!know!enough!about!Qigong!to!be!able!to!endorse!it!as!a!safe!and!“permissible”!
Integrating Qigong into Healthcare!
!
11!
practice!in!the!first!place.!The!value!of!educating!the!medical!community!in!this!regard!is!necessary!and!
truly!far!reaching!(Weaver!2019).!
!
Scientific!research!confirms!that!the!combination!of!Qigong’s!movement,!postural!alignment,!
diaphragmatic!breathing,!relaxation!exercises,!and!mindfulness!meditation!and!interoceptive!practices!
promote!health!and!healing!as!well!as!provide!adaptive!coping!and!individual!and!community!resiliency!
that!meet!prevention,!treatment,!and!rehabilitation!requirements!for!the!current!COVID-19!crisis!(Feng!
2020).!Qigong!also!broadens!the!concept!of!health!in!order!to!provide!ways!to!clinically!measure!
physical!and!emotional!well-being!and!resilience!and!provide!active!treatment!for!chronic!diseases!and!
comorbidities.!Proposed!legislation,!certification,!and!training!of!Qigong!teachers!and!practitioners!need!
to!be!informed!by!science!so!as!not!to!present!barriers!to!dissemination!of!the!practices!to!those!
individuals!and!populations!who!need!them!the!most.!Qigong!is!a!potentially!powerful!component!of!
Western!models!of!healthcare!systems!where!the!“whole!person”!is!considered!and!prevention!and!
wellness!are!primary!aspects!of!care.!!
References
!
AIS.!American!Institute!of!Stress.!America’s!#1!Health!Problem.!https://www.stress.org/americas-1-
health-problem!
!
Chen,!W.!Probing!Interoceptive!Processes.!NCCIH.!July!2020.!
https://www.nccih.nih.gov/research/blog/probing-interoceptive-processes-join-nccihs-hot-topic-
webinar-on-july-15!
!
Chodzko-Zajko,!Jahnke.!National!Expert!Meeting!on!Qi!Gong!and!Tai!Chi!Consensus!Report.!2005.!
http://www.agingblueprint.org/PDFs/ConsensusDoc.pdf!
!
Connor!MH,!Connor!CA,!Eickhoff!J,!Schwartz!GE.!Prospective!empirical!test!suite!for!energy!
practitioners.!Explore!(NY).!2021!Jan-Feb;17(1):60-69.!doi:!10.1016/j.explore.2020.07.010.!Epub!2020!
Aug!1.!PMID:!32798173.!
!
Dedoncker!J,!Vanderhasselt!MA,!Ottaviani!C,!Slavich!GM.!MENTAL!HEALTH!DURING!THE!COVID-19!
PANDEMIC!AND!BEYOND:!THE!IMPORTANCE!OF!THE!VAGUS!NERVE!FOR!BIOPSYCHOSOCIAL!RESILIENCE.!
Neurosci!Biobehav!Rev.!2021!Feb!11:S0149-7634(21)00064-6.!doi:!10.1016/j.neubiorev.2021.02.010.!
Epub!ahead!of!print.!PMID:!33582230.!
!
DHHS!2000,!Department!of!Health!and!Human!Services.!Healthy!People!2000:!National!Health!
Promotion!and!Disease!Prevention!Objectives.!Washington,!DC,!Pub.#!91-50213,!1991.!!
!
DHHS!2010,!Department!of!Health!and!Human!Services.!Healthy!People!2010:!Understanding!and!
Improving!Health.!Washington,!DC,!Pub.#!No.!017-001-00550-9,!1/2000.!!
!
Douglas,!W.!World!Tai!Chi!and!Qigong!Day!Medical!Research.!2021.!
https://www.worldtaichiday.org/WTCQDHlthBenft.html.!
Integrating Qigong into Healthcare!
!
12!
!
Eigenschink!M,!Dearing!L,!Dablander!TE,!Maier!J,!Sitte!HH.!A!critical!examination!of!the!main!premises!of!
Traditional!Chinese!Medicine.!Wien!Klin!Wochenschr.!2020!May;132(9-10):260-273.!doi:!
10.1007/s00508-020-01625-w.!Epub!2020!Mar!20.!PMID:!32198544;!PMCID:!PMC7253514.!
!
Feng!F,!Tuchman!S,!Denninger!JW,!Fricchione!GL,!Yeung!A.!Qigong!for!the!Prevention,!Treatment,!and!
Rehabilitation!of!COVID-19!Infection!in!Older!Adults![published!online!ahead!of!print,!2020!May!15].!Am!
J!Geriatr!Psychiatry.!2020;10.1016/j.jagp.2020.05.012.!doi:10.1016/j.jagp.2020.05.012.!!!
!
Frangos!E,!Richards!EA,!Bushnell!MC.!Do!the!psychological!effects!of!vagus!nerve!stimulation!partially!
mediate!vagal!pain!modulation?!Neurobiol!Pain.!2017;1:37-45.!doi:10.1016/j.ynpai.2017.03.002!
!
Fries!JF,!Koop!CE,!Beadle!CE,!et!al.!Reducing!health!costs!by!reducing!the!need!and!demand!for!medical!
services.!N!Engl!J!Med!1993;329:321–325.!
!
Garber!CE,!Blissmer!B,!Deschenes!MR,!et!al.!American!College!of!Sports!Medicine!position!stand.!
Quantity!and!quality!of!exercise!for!developing!and!maintaining!cardiorespiratory,!musculoskeletal,!and!
neuromotor!fitness!in!apparently!healthy!adults:!guidance!for!prescribing!exercise.!Med!Sci!Sports!Exerc.!
2011;43(7):1334-1359.!doi:10.1249/MSS.0b013e318213fefb!!!
!
Gerritsen!RJS,!Band!GPH.!Breath!of!Life:!The!Respiratory!Vagal!Stimulation!Model!of!Contemplative!
Activity.!Front!Hum!Neurosci.!2018;12:397.!Published!2018!Oct!9.!doi:10.3389/fnhum.2018.00397!
!
Gibson!J.!Mindfulness,!Interoception,!and!the!Body:!A!Contemporary!Perspective.!Front!Psychol.!2019!
Sep!13;10:2012.!doi:!10.3389/fpsyg.2019.02012.!PMID:!31572256;!PMCID:!PMC6753170.!
!
Harvard!Medical!School.!An!Introduction!to!Tai!Chi.!2019.!Harvard!Health!Publishing.!
!
Healer!Within!Foundation.!https://www.healerwithinfoundation.org/!
!
HD1708.!Massachusetts!Bill!HD.1708.!An!Act!Regulating!Alternative!Healing!Therapies.!
https://malegislature.gov/Bills/192/HD1708!
!
Hempel!S,!Taylor!SL,!Solloway!MR,!et!al.!Evidence!Map!of!Tai!Chi.!Washington!(DC):!Department!of!
Veterans!Affairs!(US);!2014.!
!
Hu!Y,!Kattan!C,!Kontos!D,!Zhu!W,!Hernandez!ME.!Benefits!of!tai!ji!quan!practice!on!neuromuscular!
functions!in!older!adults:!A!Systematic!Review!and!meta-analysis.!Complement!Ther!Clin!Pract.!2020!Dec!
16;42:101295.!doi:!10.1016/j.ctcp.2020.101295.!Epub!ahead!of!print.!PMID:!33341582.!
!
Huang!J,!Wang!D,!Wang!J.!Clinical!Evidence!of!Tai!Chi!Exercise!Prescriptions:!A!Systematic!Review.!Evid!
Based!Complement!Alternat!Med.!2021!Mar!10;2021:5558805.!doi:!10.1155/2021/5558805.!PMID:!
33777155;!PMCID:!PMC7972853.!
!
Integrating Qigong into Healthcare!
!
13!
Illinois.!Illinois!Senate!Bill!SB1930.!https://legiscan.com/IL/bill/SB1930/2021!
!
Iowa.!Iowa!Senate!Bill!S261.!2019.!https://legiscan.com/IA/bill/SF261/2019!
!
Irwin!MR,!Olmstead!R,!Carrillo!C,!et!al.!Tai!Chi!Chih!Compared!With!Cognitive!Behavioral!Therapy!for!the!
Treatment!of!Insomnia!in!Survivors!of!Breast!Cancer:!A!Randomized,!Partially!Blinded,!Noninferiority!
Trial![published!correction!appears!in!J!Clin!Oncol.!2017!Dec!20;35(36):4096].!J!Clin!Oncol.!
2017;35(23):2656-2665.!doi:10.1200/JCO.2016.71.0285.!
!
Jahnke,!R.!The!Healer!Within.!HarperCollins!Publishers.!1997.!
!
Jahnke!R,!Larkey!L,!et.al.!A!Comprehensive!Review!of!Health!Benefits!of!Qigong!and!Tai!Chi.!Am!J!Health!
Promot.!2010!JUL-AUG;!24(6):!e1–e25.!doi:!10.4278/ajhp.081013-LIT-248.!
!
Khalsa!SS,!Adolphs!R,!Cameron!OG,!et!al.!Interoception!and!Mental!Health:!A!!Roadmap.!Biol!Psychiatry!
Cogn!Neurosci!Neuroimaging.!2018;3(6):501-513.!!doi:10.1016/j.bpsc.2017.12.004!
!
Klein.!Know!the!Evidence.!A!report!of!the!NQA!Research!and!Education!Committee.!June!30,!2017.!
https://www.nqa.org/index.php?option=com_dailyplanetblog&view=entry&year=2017&month=10&day
=04&id=15:know-the-evidence-may-2017-updated-review!
!
Laborde!S,!Mosley!E,!Thayer!JF.!Heart!Rate!Variability!and!Cardiac!Vagal!Tone!in!Psychophysiological!
Research!-!Recommendations!for!Experiment!Planning,!Data!Analysis,!and!Data!Reporting.!Front!
Psychol.!2017!Feb!20;8:213.!doi:!10.3389/fpsyg.2017.00213.!PMID:!28265249;!PMCID:!PMC5316555!
!
Larkey!L,!Jahnke!R,!et.!al.!Meditative!Movement!as!a!Category!of!Exercise:!Implications!for!Research.!
Journal!of!Physical!Activity!and!Health!2009.!6.!230-238.!
!
Larkey!LK,!Roe!DJ,!Weihs!KL,!et!al.!Randomized!controlled!trial!of!Qigong/Tai!Chi!Easy!on!cancer-related!
fatigue!in!breast!cancer!survivors.!Ann!Behav!Med.!2015;!49(2):165-!176.!doi:10.1007/s12160-014-9645-
4.!!
!
Leskowitz,!E.!A!cartography!of!energy!medicine:!From!subtle!anatomy!to!energy!physiology.!Explore.!
2020,!Nov.!DOI:!10.1016/j.explore.2020.09.008!
!
Li!F,!Harmer!P,!Chou!LS.!Dual-Task!Walking!Capacity!Mediates!Tai!Ji!Quan!Impact!on!Physical!and!
Cognitive!Function.!Med!Sci!Sports!Exerc.!2019;51(11):2318-2324.!
doi:10.1249/MSS.0000000000002051.!!
!
Liu,!T.!Chinese!Medical!Qigong.!Singing!Dragon.!2010.!
!
Lucas!AR,!Klepin!HD,!Porges!SW,!Rejeski!WJ.!Mindfulness-Based!Movement:!A!Polyvagal!
Perspective.!Integr!Cancer!Ther.!2018;17(1):5-15.!doi:10.1177/1534735416682087.!
!
Integrating Qigong into Healthcare!
!
14!
Mass.!Massachusetts!Bill!S.168.!An!Act!Regulating!Bodyworks.!
https://legiscan.com/MA/bill/S2634/2019.!
!
Mehling!WE,!Acree!M,!Stewart!A,!Silas!J,!Jones!A.!The!Multidimensional!Assessment!of!Interoceptive!
Awareness,!Version!2!(MAIA-2).!PLoS!One.!2018;13(12):e0208034.!Published!2018!Dec!4.!
doi:10.1371/journal.pone.0208034!
!
Melzack!R.!Pain!and!the!neuromatrix!in!the!brain.!J!Dent!Educ.!2001!Dec;65(12):1378-82.!PMID:!
11780656.!
!
Miller!C.!An!interview!with!Diane!Miller,!JD.!Spirit!of!Change.!
https://www.spiritofchange.org/protecting-your-access-to-health-care-freedom-in-massachusetts/!
!
NPC.!National!Prevention!Council.!Healthy!Aging!in!Action.!Washington,!DC:!U.S.!Department!of!Health!
and!Human!Services,!Office!of!the!Surgeon!General;!2016.!!
https://www.cdc.gov/aging/pdf/healthy-aging-in-action508.pdf!
!
NQA.!National!Qigong!Association.!Legislation!Committee.!Qigong!Legislation.!2021.!
https://www.nqa.org/legislation-updates!
!
Oklahoma.!Senate!Bill!190.!2020.!https://legiscan.com/OK/text/SB190/2020!
!
Osypiuk!K,!Thompson!E,!Wayne!PM.!Can!Tai!Chi!and!Qigong!Postures!Shape!Our!Mood?!Toward!an!
Embodied!Cognition!Framework!for!Mind-Body!Research.!Front!Hum!Neurosci.!2018!May!1;12:174.!doi:!
10.3389/fnhum.2018.00174.!PMID:!29765313;!PMCID:!PMC5938610.!
!
Osypiuk!K,!…Wayne!P.!Qigong!Mind-Body!Exercise!as!a!Biopsychosocial!Therapy!for!Persistent!Post-
Surgical!Pain!in!Breast!Cancer:!A!Pilot!Study.!H-.*:4(6$-,*4(!/*4.!2020;!19:1534735419893766.!
doi:10.1177/1534735419893766.!
!
Pavlov!VA,!Tracey!KJ.!The!vagus!nerve!and!the!inflammatory!reflex--linking!immunity!and!metabolism.!
Nat!Rev!Endocrinol.!2012!Dec;8(12):743-54.!doi:!10.1038/nrendo.2012.189.!PMID:!23169440;!PMCID:!
PMC4082307.!
!
Payne!P,!Crane-Godreau!MA.!Meditative!movement!for!depression!and!anxiety.!Front!Psychiatry.!
2013;4:71.!Published!2013!Jul!24.!doi:10.3389/fpsyt.2013.00071.!
!
Porges!SW.!The!polyvagal!theory:!new!insights!into!adaptive!reactions!of!the!autonomic!nervous!system.!
Cleve!Clin!J!Med.!2009!Apr;76!Suppl!2(Suppl!2):S86-90.!doi:!10.3949/ccjm.76.s2.17.!PMID:!19376991;!
PMCID:!PMC3108032.!
!
Qigong.!Qigong!Institute.!Qigong!and!Energy!Medicine!Database!™.!2021.!
https://qigonginstitute.org/abstracts!
!
Integrating Qigong into Healthcare!
!
15!
Quadt!L,!Critchley!HD,!Garfinkel!SN.!The!neurobiology!of!interoception!in!health!and!disease.!Ann!N!Y!
Acad!Sci.!2018;1428(1):112-128.!doi:10.1111/nyas.13915.!
!
Quintana.!Heart!rate!variability:!physiology,!methodology!and!experimental!possibilities.!2019.!
https://osf.io/y6zmt/!
!
Rhode.!Rhode!Island!House!Bill!H5154!(also!S2232!2020).!2021.!!
http://webserver.rilin.state.ri.us/BillText21/HouseText21/H5154.pdf!
!
Rogers!T,!Weaver!J.!Regulating!the!Teaching!and!Practice!of!Qigong!and!T’ai!Chi.!Qi!Journal.!Vol!29.!No.!
2.!Summer!2019.!
!
Ross!CL.!Energy!Medicine:!Current!Status!and!Future!Perspectives.!Glob!Adv!Health!Med.!2019!Feb!
27;8:2164956119831221.!doi:!10.1177/2164956119831221.!PMID:!30834177;!PMCID:!PMC6396053.!
!
Ross!CL.!Integral!healthcare:!the!benefits!and!challenges!of!integrating!complementary!and!alternative!
medicine!with!a!conventional!healthcare!practice.!Integr!Med!Insights.!2009;4:13-20.!doi:!
10.4137/imi.s2239.!Epub!2009!Oct!19.!PMID:!21614160;!PMCID:!PMC3093682.!
!
SD1068.!Massachusetts!Bill!SD.1068.!An!Act!Regulating!Alternative!Healing!Therapies.!
https://malegislature.gov/Bills/192/SD1068!
!
Schmalzl!L,!Crane-Godreau!MA,!Payne!P.!Movement-based!embodied!contemplative!practices:!
definitions!and!paradigms.!Front!Hum!Neurosci.!2014;8:205.!Published!2014!Apr!14.!
doi:10.3389/fnhum.2014.00205.!
!
Song!R,!Roberts!BL,!Lee!EO,!Lam!P,!Bae!SC.!A!randomized!study!of!the!effects!of!t'ai!chi!on!muscle!
strength,!bone!mineral!density,!and!fear!of!falling!in!women!with!osteoarthritis.!J!Altern!Complement!
Med.!2010;16(3):227-233.!doi:10.1089/acm.2009.0165.!
!
van!Dam!K.!Individual!Stress!Prevention!through!Qigong.!Int!J!Environ!Res!Public!Health.!2020!Oct!
8;17(19):7342.!doi:!10.3390/ijerph17197342.!PMID:!33050017;!PMCID:!PMC7579037.!
!
Wade!DT,!Halligan!PW.!The!biopsychosocial!model!of!illness:!a!model!whose!time!has!come.!Clin!
Rehabil.!2017!Aug;31(8):995-1004.!doi:!10.1177/0269215517709890.!PMID:!28730890.!
!
Watford!TS,!O'Brien!WH,!Koerten!HR,!Bogusch!LM,!Moeller!MT,!Sonia!Singh!R,!Sims!TE.!The!mindful!
attention!and!awareness!scale!is!associated!with!lower!levels!of!high-frequency!heart!rate!variability!in!a!
laboratory!context.!Psychophysiology.!2020!Mar;57(3):e13506.!doi:!10.1111/psyp.13506.!Epub!2019!
Nov!17.!PMID:!31737916.!
!
Wayne,!P.!The!Harvard!Medical!School!Guide!to!Tai!Chi.!Shambhala.!2013.!
!
Integrating Qigong into Healthcare!
!
16!
Weaver!J,!Rogers!T.!COMMENT!ON!Accreditation!Standard!Guideline!Initiative!for!Qigong!Instructors!
and!Training!Institutions.!ResearchGate.!2019.!https://qigonginstitute.org/upload/tinymce-
editor/docs/CommentMTCQ.pdf!
!
Yang!G-Y,!Wang!L-Q,!Ren!J,!et!al.!(2015)!Evidence!Base!of!Clinical!Studies!on!Tai!Chi:!A!Bibliometric!
Analysis.!Scherer!RW,!ed.!;I"J(KL9.!2015;10(3):e0120655.!doi:10.1371/journal.pone.0120655.!
!
Yeh!GY,!McCarthy!EP,!Wayne!PM,!Stevenson!LW,!Wood!MJ,!Forman!D,!Davis!RB,!Phillips!RS.!Tai!chi!
exercise!in!patients!with!chronic!heart!failure:!a!randomized!clinical!trial.!Arch!Intern!Med.!2011!Apr!
25;171(8):750-7.!doi:!10.1001/archinternmed.2011.150.!PMID:!21518942;!PMCID:!PMC3277798.!
!
Yu!P,!Li!W,!Li!H,!Ouyang!S,!Cai!H,!Wu!J,!Tang!C,!Huang!Q.!The!efficacy!and!safety!of!health!qigong!for!
anti-aging:!Protocol!for!a!systematic!review!and!meta-analysis.!Medicine!(Baltimore).!2020!Dec!
4;99(49):e22877.!doi:!10.1097/MD.0000000000022877.!PMID:!33285677;!PMCID:!PMC7717840.!
!
Zhang!Y,!Yao!F,!Kuang!X,!Li!L,!Huang!L,!Zhou!Q,!Peng!J,!Chang!Q.!How!Can!Alternative!Exercise!Traditions!
Help!Against!the!Background!of!the!COVID-19!in!Cancer!Care?!An!Overview!of!Systematic!Reviews.!
Cancer!Manag!Res.!2020!Dec!17;12:12927-12944.!doi:!10.2147/CMAR.S282491.!PMID:!33363409;!
PMCID:!PMC7753005.!!
!
Zou!L,!Yeung!A,!Quan!X,!et!al.!Mindfulness-Based!Baduanjin!Exercise!for!Depression!and!Anxiety!in!
People!with!Physical!or!Mental!Illnesses:!A!Systematic!Review!and!Meta-Analysis.!Int!J!Environ!Res!
Public!Health.!2018;15(2):321.!Published!2018!Feb!12.!doi:10.3390/ijerph15020321.!!
!
!