BMJ (Nov. 29, 2000): http://www.bmj.com/cgi/eletters/320/7237/803/a#11071

Kevin Chen, Ph.D. MPH
Assistant Professor of Psychiatry
UMDNJ- New Jersey Medical School

Dear Editor,

After reading Lee's letter to editor on "Chinese hypnosis can cause Qigong-induced mental disorders,"[1] I felt a little uneasy about the perspective expressed by him and the concerns that other psychiatrists and physicians may raise. As a research scientist who practices Qigong for years, I feel obligated to clarify some issues on what is Qigong and what are the Qigong-induced mental disorders. As Qigong becomes more and more popular around the world, these issues will catch western physicians' attention sooner or later.

1. What is Qigong?

Qigong is one of the oldest traditional Chinese health care methods, and is widely believed in China to have special healing and recovery power. Traditional Chinese medicine (TCM) posits the existence of a subtle energy (Qi), which circulates throughout all life being, and when strengthened or balanced, can improve health and ward off or slow the progress of disease. Traditionally Qigong therapy as an ancient TCM healing technique was passed from generation to generation in a private and secret manner. Only recently has Qigong become a public health practice in China and around the world. Today it is reported that 70 million people practice Qigong in China and undocumented numbers practice around the world to treat diseases ranging from hypertension and arthritis to cancer and HIV [2-7].

All Qigong are not the same, we should not simply classify Qigong as Chinese hypnosis or healing based on trance. Qigong is a general term for a huge variety of forms of traditional exercises and therapies. They may be roughly divided into two large categories (movement Qigong and static meditation) and five major disciplines or traditions: the Confucian, Buddhist, Taoist, medicine and martial arts. If I told you that the popular Tai Chi Chuan was originated from secret Tai Chi Men Qigong, and considered the movement form of Qigong, you may no longer want to classify Qigong as hypnosis. Each of the five Qigong traditions has its own purposes of training or practice, as well as different methods and various forms to achieve those purposes. For example, the Buddhist Qigong tends to emphasize the cultivation of virtue and enlightening wisdom, and it considers the human body just a stinking bag holding the honorable spirit. While martial-art Qigong emphasizes building up the body strength for fighting and defense. Yet many martial-art Qigong practitioners have died prematurely due to over exerting their body limits. Although various forms of Qigong might all have some reported health benefits, not all Qigong were designed for the purpose of health care or disease curing, only medical Qigong takes treating illness or curing disease as its major purpose.

Most Qigong practice involves some form of imagery meditation, deep relaxation, or guided movement, and mind-body integration through regulation and adjustment of body, breath and mind. Because of the deep relaxation and "empty-mind" status during practice, it is reported that Qigong practitioners usually have more efficient oxygen metabolism, increased blood flow in the brain and a slower pulse rate [2, 8]. Good Qigong practitioners in deep meditation and tranquility status seem beyond their regular five senses, and unable to follow outside instructions like the hypnotized subjects do. Many psycho-physiological changes reported by Benson in relaxation responses can be found among Qigong practitioners. However, Qigong practice seems more than just relaxation; practitioners are said to develop an awareness of Qi sensations in their bodies and use their mind or intention to guide the Qi. Some skillful Qigong practitioners can reportedly direct or emit their Qi energy (external Qi) for the purpose of healing others.

2. How Qigong Works for Health Purposes?

The mechanism of how Qigong works to achieve health benefits is still the subject of further scientific exploration. However, according to TCM, the available scientific literature and my own experience with Qigong, it works to benefit the practitioners through the following three possible paths.

(1) The relaxation and tranquility status related to Qigong practice may reverse the chronic stress, build up the Qi (energy) or rapidly increase the immune function [9]. This results in defeating certain health problems related to immune malfunction or immune deficiency.

(2) The emphasis of "empty mind without desire" in Qigong practice may help the practitioners release the suppressed emotion or straighten up the twisted mental disturbance. Many chronic diseases of unknown origin may be well related to this mental disturbance or emotional twist. During some high-quality Qigong practice, practitioners tend to forget about the disease, forget about the worrisome, forget about the environment and forget about the self. They can behave as if they entered a place where they can do whatever they want. Then we may observe sudden and frequent emotional breakouts, such as crying, laughing, dancing, jumping and turning around among the practitioners. Onlookers without Qigong knowledge will definitely consider these movement mental disorders. After this type of emotional breakout, the practitioners will feel some unusual relief in their body and mind, and many discomforts may disappear immediately. It was reported that a form of Qigong called "Hui Tong Dan Tian Gong" (Intelligence through Dan Tian) in China was especially effective in treating schizophrenia. Schizophrenia patients came to the in-patient clinic and practiced this form of Qigong continuously in a mental "disorder" way under close supervision. After one to two weeks of practice, they could walk out of the clinic schizophrenia-free and return to normal life.

(3) Motivated Qi (vital energy) strikes against sick locations. According to TCM, good health is a result of a free flow, well-balanced Qi (energy) system, while sickness or the experience of pain is the result of Qi blockage in certain areas or unbalanced energy in the body. Qi imbalance occurs before any physical illness occurs. In order to stay healthy and function well, people need to perform Qigong exercises to keep the Qi flowing smoothly in the body so that each cell in the body gets a constant supply of vital energy. Once the supply of Qi to the cells become blocked, blood flow to that area will change, the cells or related organs might start to malfunction, and disease or pain may occur [10, 11]. One possible mechanism of Qigong therapy for pain relief and symptom reduction is through the relaxation of diseased or stressed tissues and the increased strength of Qi flow to blocked areas. This leads to increased blood flow to the afflicted area of the body. Increased blood flow implies a more efficient delivery of oxygen, nutrients and pain-killing substances, including the delivery of drugs as well as a more efficient removal of metabolic waste products that could contribute to pain and sickness [11].

3. Qigong-Induced Mental Disorders

Can Qigong practice really induce madness or mental disorders? The answer is yes and no. The fact is that, through the history of Qigong practice, there are indeed a few in the million of practitioners who derived no benefits but did go on to manifest some form of distress or deviation. From a psychiatric perspective, their symptoms have no difference from mental disorders as defined in the DSM book. However, most cases of Qigong-induce mental disorders or ultra deviation ("Zou huo ru mo") occurred among those who practiced Qigong under merit-less Qigong instructors or without any supervision at all. There were simply no reports of mental disorders under the guidance of a knowledgeable Qigong master. After a closer examination of those Qigong-induced mental disorders, we find that many Qigong-induced deviations or "disorders" have simply been a "false report".

According to the analysis of knowledgeable Qigong masters and my own experience, there are three major types of so-called Qigong-induced "mental disorders" that we may see in clinic: (1) Somatic responses to Qi practice. Many mental disturbances or deviations are not a sign of madness, but rather a normal reaction during the Qigong healing stage when potential diseases appear and old diseases reemerge due to the strengthened Qi striking against the blocked locations [12]. A subsequent condition of intense pressure is experienced when the real Qi (vital energy) in our body tries to push through the three major gateways on the Du meridian. This accounts for the somatic stresses like swelling at the cerebellum, loud echoes in the ear, swelling and pain in the neck, shoulders, and arms. These are supposed to be good signs of Qigong progress, rather than a mental disorder. (2) Out-of-control or spontaneous movement and/or emotional expression (sudden laughing or crying). This occurs sometimes among those involved practitioners whose poor health conditions lead to this kind Qi-related movement but lack the appropriate guidance or supervision. They are either not closing a practice properly, or getting into a deep Qigong status, which probably needs continuous practice over the course in a few days. However, if the inept practitioners stop practicing and search for medical help, the situation may last much longer. Those without the guidance of a knowledgeable Qigong instructor may be inclined to reach the false conclusion that these disturbance were prelude to madness or deviation. The unfortunate end result may be that the person who most requires more Qigong practice would discontinue it, and seek unnecessary medical help for no better reason than fear and worry [12]. (3) Illusive sight or hearing. In the higher level of Qigong practice, about 1/3 of students or practitioners may report strange and illusive images or hearing. Although this phenomenon has not been well understood by scientists, it occurs repeatedly among those involved practitioners, and usually accompanies rapid progress in Qigong level. One of the common characteristics of these illusive sights and hearings is that some of them might be truth or become reality to the practitioners later, which make the practitioners unable to tell the difference between a hallucination and an accurate perception. This is called the "Zeng Wang Xiang Gong" stage where true and false scenes conflict, an experience most advanced Qigong practitioner experienced. It is normal from the perspective of Qigong practice, but will definitely be considered a mental disorder by those who lack knowledge of Qigong. This may be one of the reasons why Qigong was traditionally passed down in a private and secret manner.

In addition, there are those who practice Qigong with less honorable motives, namely, notoriety and wealth. Some of these people seek what may be called a quick-fix, i.e. immediate recovery and instant success. Some of them practiced Qigong for the purpose of reclaiming the supernatural power or communicating with the spiritual world. Needless to say, these wholly contradict the basic principles of Qigong practice, "a life of simplicity and empty mind without desires". These ambitious and wrong-headed practitioners wish to distinguish themselves by mastering certain techniques such as "seeing with the third eye," levitation, moving objects by intention, and ability to foresee the future. Those who seek such power and misuse it will soon find themselves exhausted of all inborn energy, deviated from normal Qi flow, and will themselves become "mentally disturbed." All these unwholesome actions defy the laws of Nature and the Way ("Dao"), should not be understood as a falsity of Qigong practice.

In short, most Qigong-induced mental disorders are the results of practice without the proper knowledge of Qigong. In these cases, physicians may consider a consultation with a knowledgeable Qigong master first, and let the patient complete his normal course of Qigong practice before taking any necessary medical treatment.

(Contact author by email: chenke@umdnj.edu)

References:

1. Lee S. 2000. Chinese hypnosis can cause qigong induced mental disorders. BMJ, 320:803 (18 March, 2000)
2. Feng, Lida, 1994. Modern Qigong Science. Beijing: Economic Science Publisher.
3. Liu H, and Perry P, 1997. The Healing Art of Qi Gong: Ancient Wisdom from a Modern Master. New York: Warner Books, Inc.
4. McGee, CT with Chow EPY, 1994. Miracle Healing from China: Qigong. Coeur d'Alene.
5. Mayer M, 1999. "Qigong and hypertension: A critique of research." The Journal of Alternative and Complementary Medicine. 5, 371-382.
6. Sancier KM. 1996. "Medical Applications of Qigong." Alternative Therapies in Health and Medicine, 2(1): 40-45.
7. Sancier KM. 1999. Therapeutic benefits of Qigong exercises in combination with drugs. Journal of Alternative and Complementary Medicine, 5, 383-389.
8. Jahnke R. 1990. "The physiological and energetic mechanisms triggered in the human system by the self-applied health enhancement methods: Qigong, Taiji, Yoga and mind/body health improvement practices." In Proceedings of the 5th International Congress of Chinese Medicine and the First International Congress of Qigong. June 22-23, 1990. CA: University of California at Berkeley.
9. Ryu H, Jun CD, Lee BS, Choi BM, Kim HM, & Chung HT, 1995. "Effect of Qigong training on proportions of T lymphocyte subsets in human peripheral blood." American Journal of Chinese Medicine. 23(1): 27-36.
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11. Yang, JM, 1996. Arthritis: The Chinese Way of Healing and Prevention. Jamaica Plain, MA: YMAA Publication Center.
12. He, B. 1994. Breaking the Secret of Qigong, Guangzhou: ZhongShan University Press.