effect of qigong on arthritis

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Effects of Qigong Therapy on Arthritis: A Review and Report of a Pilot Trial

Kevin W Chen1 and Tianjun Liu21University of Medicine and Dentistry of New Jersey, Robert

Wood Johnson Medical School, Piscataway, NJ, USA, and World Institute for Self-Healing, Inc., Middlesex, NJ, USA

2Laboratory of Qigong Research, Beijing University of Chinese Medicine, Beijing, China

JUNE 2004 - Volume 1, Number 1

AbstractBackground: Patients with chronic pain,like arthritis, are increasingly seeking alter-natives to Western medicine. Many havebenefited from acupuncture, a traditionalChinese medicine (TCM) therapy. TCM the-

ory purports that arthritis is due to a block-age of the qi flow. Qigong therapy, likeacupuncture, is said to alter qi flow andstrengthen internal qi, either through self-practice or through external qi emission.Objective: To review the literature ofqigong therapy for arthritis, to help furtherunderstanding of the possible applications ofqigong therapy in pain relief, and to reportthe results of an open pilot study of externalqi therapy for arthritis. Methods: Literature derived from Medline,Qigong Database, China National Knowle-dge Infra-structure (CNKI), and the librarydatabase at the Beijing University of Med-icine cover both the reviews of open trialswithout control and randomized control tri-als. In our open trial, 10 patients with arthri-tis were recruited, and six of them complet-ed all 3 treatments and a 1-month follow-upexam.Measures: In our pilot study, the visual ana-logue scales (VAS) on pain and mood wereused pre- and post-treatment. Other meas-ures included the physical disability scale;the Spielberger anxiety scale, and theswollen/tender joint count. Results: All patients in our study reportedsome degree of symptom relief, reduction inpain and negative mood, a decreased anxietyscore, and reduced active pain/tenderness injoints (except one subject), and reduction inmovement difficulty scores. Two partici-pants reported complete relief without anypain 1 month after the treatment.

Corresponding Author:Kevin W Chen, PhD, MPHDepartment of PsychiatryUMDNJ – Robert Wood Johnson MedicalSchool671 Hoes Lane WestUBHC-D453Piscataway, NJ 08854Fax: 732-235-5818E-mail: [email protected]

Acknowledgement: The authors would like to thank Dr. G.Rihacek and master Binhui He for theirinvolvement and significant contribution tothe open trial of the pilot study; and alsothe volunteers at the World Institute for SelfHealing (http://www.wishus.org) for theirhelp with the data collection and literatureresearch. The Chinese literature review waspartially supported by a research grantfrom the Qigong Institute in California(http://www.qigonginstitute.org). We alsoappreciate Mr. Liu Feng for his assistancein the literature review, and Dr. Ley A.Killeya-Jones for her help in editing andcommenting on an earlier version of themanuscript.

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Conclusions:The literature review suggeststhat there is strong evidence for a therapeu-tic effect of qigong on reducing pain andrelieving the symptoms ofarthr i t is .Although our pilot trial is far from conclu-sive due to the small sample size withoutcontrol, the results suggest that further stud-ies are warranted to determine the efficacyof qigong therapy for arthritis with a largersample.Keywords: qigong, bioenergy therapy,energy medicine, arthritis, review, painrelief, anxiety, functional movement.

IntroductionAccording to the Arthritis Foundation®,approximately one out of seven people in theUnited States have arthritis of some kind. Itis the number one cause of disability in theUS and limits everyday activity for approxi-mately seven million people. Although cur-rent pharmacological therapy is usuallyeffective in relieving symptoms, it does notprovide an effective cure and can have seri-ous drawbacks, such as toxicity and highcosts. Many patients now seek non-Westernmedical approaches to treat their arthritisproblems, including musculoskeletal thera-pies (1,2) and other methods of physical andemotional pain relief (3). An effective non-pharmacological therapy for arthritis that iswithout side effects and returns a sense ofself-efficacy to the patient would be animportant addition to our armamentarium.Qigong, a family of traditional Chinese med-icine therapies shows promise in this direc-tion.

What is Qigong? Qigong (pronounced chi kung) is a generalterm for a wide variety of traditional Chineseenergy exercises and therapies. TraditionalChinese medicine (TCM) posits the exis-tence of a subtle energy (qi) that circulatesthroughout the body. Strengthening or bal-ancing qi can improve health and ward off

disease. The Chinese have practiced qigongfor thousands of years. Historically, qigongtraditions were passed from generation togeneration in a private and secret manner.Only recently has it become a public healthpractice in China. It has been reported thattoday, more than 100 million people practiceqigong in China and more practice it aroundthe world to treat diseases ranging fromhypertension and arthritis to cancer and HIV(4-8).

The word qigong is a combination oftwo Chinese ideograms: "qi," meaning"breath of life", or "vital energy," and"gong," meaning "skill or achievement,"which implies time accumulation. In gener-al, “Qigong is a self-training method orprocess in which qi and yi (intention) arecultivated through adjustment of body pos-ture, breathing and mental state to achievethe optimal state of both body and mind. Thevarious qigong forms may involve tech-niques such as relaxation, breath adjustment,slow movement, mind regulation, guidedimagery, biofeedback, mindfulness medita-tion, or advanced mind-body integration.Although most qigong forms might havesome health benefits, they were not createdfor the purpose of healing. Only medicalqigong has the primary focus of treating ill-ness or curing disease.

According to TCM theory, goodhealth is a result of a free-flowing, well-bal-anced qi system, while sickness or the expe-rience of pain is the result of qi blockage orunbalanced energy in the body. Qigong ther-apy in the medical qigong tradition consistsof internal qigong self-practice and externalqi healing. Qigong practitioners are reportedto have more efficient oxygen metabolismand a slower pulse rate than the general pop-ulation (8). Qigong practitioners are said todevelop an awareness of qi sensations intheir bodies and to use their intention toguide the qi flow.

TCM practitioners apply qi emission

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or external qi in their diagnoses and healingprocesses. External qi therapy (EQT) is theprocess in which qigong practitioners director emit their qi energy to help others breakthe qi blockage and remove the sick qi fromthe body. Balancing and opening the qi sys-tem relieves pain and eliminates disease(there is some similarity to therapeutictouch, which is done in the US). Althoughthe physical and biological nature of qiremains unknown, some reports suggest "qi-emission" might induce physical, biophysi-cal and/or biochemical alterations. Forexample, "qi-emission" by a qigong healerhas been reported to be associated with sig-nificant structural changes in aqueous solu-tions, to enable the growth of Fab proteincrystals (9), inhibit tumor growth in mice(10), change the conformation of biomole-cules like polyglutamic acid or polylysine(11), and reduce phosphorylation of a cell-free preparation (12). Thus there is a smallbut growing body of scientific evidence thatsupports the existence of qi, as well as thehealing power of qigong therapy (6,13-17).

Arthritis from the Chinese MedicinePerspectiveArthritis is called "bi zheng" (zheng = symp-tom) in TCM. The Yellow Emperor’s Classicof In-ternal Medicine (a Chinese medicalbook written approximately 2,500 years ago)describes "bi" as "wind, cold (chilly) anddamp three qi mixed in the body becomingbi. The excessive wind qi leads to movementbi, the excessive cold qi leads to pain bi, andthe excessive damp qi leads to swelling bi."The Yellow Emperor’s Classic also pointsout that "weakness of qi in the body is thecause of sickness and pain".

According to TCM literature, qiimbalance is frequently due to various phys-ical and emotional disturbances. An internalqi imbalance occurs before any physical ill-ness arises. In order to stay healthy and func-tion well, people need to conduct qigong or

other exercises to keep the qi flowingsmoothly so that each cell in the body gets aconstant supply of this energy. Once the sup-ply of qi to the cells becomes irregular orunbalanced, the blood flow will also becomeblocked in that area, the cells or relatedorgans might start to malfunction, and dis-ease or pain will occur (18).

TCM believes that arthritis is theresult of the body being invaded by wind-cold-damp qi at a vulnerable time or place,which can easily cause qi blockage in certainjoints where the wind-cold-damp qi resides.The invasion of wind-cold-damp qi can hap-pen in different ways. For example, workingtoo hard in bad weather, or having sex at thebeach or in a cold, wet place, or touchingitems that are cold after giving birth could allmake one extremely vulnerable to the inva-sion of wind-cold-damp qi (19). Therefore,the treatments for arthritis from a TCM per-spective mostly focus on ridding the body ofthe wind-cold-damp qi, breaking the qiblockage in the painful area, and supplyingthe area with healthy and balanced qi (tostrengthen the internal qi). Both acupunctureand qigong therapy follow the same princi-ples in treating arthritis pain, and most ofthem have some reported effectiveness(14,18-21).

Thirty years ago, during USPresident Richard Nixon’s trip to China, theAmerican public first became aware ofTCM, including acupuncture. Since then, theinterest in and use of acupuncture by patientshas been expanding. One of the most com-mon uses of acupuncture has been for thetreatment of musculoskeletal syndromes,including low back pain, osteoarthritis,fibromyalgia and Raynaud’s phenomenon(20,21). A precise role for acupuncture hasnot yet been established in Western medicalpractice (22). The key for acupuncture ther-apy is the meridian system in the humanbody. The meridian system maps the majorchannels of qi flow. Although we still do not

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fully understand the mechanism of acupunc-ture and qi flow in the human body, it hasbecome a popular and successful alternativetherapy in US healthcare. The NationalInstitutes of Health (NIH) funded a largeclinical trial at the University of Maryland tostudy the treatment of osteoarthritis in theknees using acupuncture, which achievedsome positive results (23). Like acupunc-ture, qigong therapy also affects meridian qiflow, but it is easier to carry out, has fasterpatient response and induces less anxiety.

Although qigong as an alternativetherapy has gained increased popularity inthe US as well as around the world (1,3), lit-tle scientific documentation can be found inthe Western literature. Thus, there is a largegap between the increased demand fromconsumers and physicians who want to useqigong and the available scientific evidencesupporting the effectiveness of this therapy.First, this paper will present a review ofsome clinical studies from China examiningthe effects of qigong therapy on arthritis, andthen we will report the results of an opentrial of external qi therapy for relievingarthritis pain.

Review of Qigong Therapy for ArthritisIt is well known that qigong practice is ben-eficial in preventing disease and strengthen-ing immunity (5 ,8 ), but it is lessknown,even in China, that this therapy can be aneffective means for relieving pain and treat-ing arthritis. However, the number of reportsin the Chinese literature that document thetherapeutic effect of qigong therapy onarthritis are increasing. The studies werederived from Medline, Qigong Database,China National Knowledge Infrastructure(CNKI), and the library database at theBeijing University of Medicine and includea number of clinical studies, mostly opentrial without control, and some randomizedcontrol trials. The following is a summaryreview of this body of literature.

Open Trials without ControlMany reports on qigong treatment of arthri-tis were open trials without a randomizedcontrol group. They involved qigong self-practice, and sometimes, external qi therapyin combination with other therapies. Forexample, Zheng (24) introduced qigongtherapy to 295 chronic rheumatoid arthritispatients (aged 20 to 62; 200 females, 95males), who had failed to show any benefitsfrom other treatments. Patients were taughtto practice standing qigong everyday for 2months. In addition, a qigong healer per-formed EQT or acupuncture to help promoteblood circulation and relieve pain (onceeveryday), with 10 days counting as onetreatment course. They found that 192patients (67.2%) reported complete short-term cure (i.e., their pain disappeared, jointfunction was normal, rheumatoid factor inthe blood was negative, the erythrocyte sed-imentation rate (ESR) was normal, and theydid not experience any recurrence within 6months). Eighty-three cases (28.4%) showedsignificant improvement, i.e., most symp-toms had disappeared, they did not experi-ence any more pain, but the ESR was stillabnormal and joint function was limitedslightly. Fourteen cases (4.4%) reportedsome improvement in pain relief or move-ment function. However, there was no con-trol group in this study, and the results mightbe discounted due to the possibility of place-bo effects.

Li (25) conducted a similar clinicaltrial with 120 rheumatoid arthritis patients(aged 12-74; 32 males and 88 females) whohad unsatisfactory results with other thera-pies. With external qi therapy (qi emission toacupoints or pain area) as the major treat-ment, plus acupuncture and qigong self-practice (3 hours per day) for a period of 1 to4 months, it was reported that 23% of thepatients had a complete cure, i.e., all clinicalsymptoms disappeared, the rheumatoid fac-tor was negative, the ESR was normal, drug

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therapy was discontinued, and there was nosymptom relapse in 6 months. Sixty-threepercent had significant improvement, i.e.,most clinical symptoms disappeared, theydid not experience any more pain, but theESR was still abnormal. Ten percent report-ed some improvement, and only 4% experi-enced no effect at all. Even so, this studymay not be conclusive due to the lack of acontrol group.

Ren and Mu (26) applied a complextherapy combining acupuncture, acupressureand qigong to treat 250 rheumatoid arthritispatients (108 males, 142 females; mean age= 42.2 years). The average course of theirdisease was 31.5 years. Most patients (242)had tried many other therapies before thistrial with little improvement. The treatmentincluded the self-practice of qigong, once ortwice daily. In addition, the qigong healerguided qi to acupoints, as well as usingacupuncture and/or massage therapy toimprove the microcirculation system. Eachtreatment course lasted 10 days. The resultswere as follows: • 102 cases (40.8%) showed complete

recovery, i.e., clinical symptoms disap-peared with recovered movement andfunction

• 95 cases (38%) showed distinct improve-ment, i.e., symptoms disappeared withrecovered function, but some felt painwhen the weather changed

• 53 cases (21.2%) showed some effect, i.e.,symptoms were ameliorated greatly.

The authors concluded that this kind of com-plex treatment was beneficial for rheumatoidarthritis patients.

Liu (27) applied EQT plus massageto 65 patients (24 males and 41 females)with scapulohumeral periarthritis, who hadshown no improvement after physical thera-py or other massage manipulations. Thehealer first massaged the subject’s arthriticarm from shoulder to hand, and then emitted

qi to the patient’s shoulder joint for 5 min-utes. The EQT treatment was carried outonce per week for 2 to 4 weeks. Meanwhile,the patients engaged in daily self-practice ofqigong. As a result, 60 cases (92%) werecompletely cured, i.e., they were pain freeand had normal function, 3 cases (5%)showed significant improvement, and only 2cases (3%) showed no effect, according tothe Therapeutic Efficacy Standard ofClinical Disease by the Chinese HealthDepartment of the Army (the most commonstandard used by Chinese doctors). Liu con-cluded that qi-conducting acupressure is agentle and good method for treating scapulo-humeral periarthritis.

Many open trials like these can befound in the Chinese medical literature.These reports document effectiveness ofqigong therapy when combined with othertherapies. For example, Hu and Huangapplied qigong therapy with massage to 47patients with cervical spondylopathy, andreported that 53% were completely curedand 25% showed significant improvement(28). Gao applied a similar therapy (qigongexercise combined with massage) to treat 51patients with cervical spondylopathy, andachieved a 73% cure rate, and a further 27%showing significant improvement in 6months (29).

Other studies suggested the effec-tiveness of qigong therapy alone. For exam-ple, Li et al. treated 40 chronic rheumatoidarthritis patients who had failed to respondto other therapies with qigong (self practiceof qigong 6 hours daily for 3 months), andfound that 57% of the rheumatoid arthritispatients had significant clinical improve-ment and some were even completely curedby qigong practice (30). Xi (31) taughtGuided Congenital Qigong for 10 to 30 daysto 30 patients with arthromyodynia, andreported that 11 patients had been complete-ly cured and 8 patients showed significantimprovement. Although these studies lack

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compatible control groups, they appear tohave offered the patients an effective altern-ative treatment for their "incurable" arthritis.

Randomized Control TrialsDr. Feng (8,32) conducted a study ofrheumatoid arthritis patients in a randomizedcontrol trial. Sixty patients (aged 18 to 59;31 males and 29 females) were randomlydivided into two groups: qigong therapygroup and indomethacin (Indocin®, Merck& Co., Inc., Whitehouse Station, NJ) treatedgroup (N = 30 each). The patients in theqigong group were treated by EQT, plusgroup qigong practice 1 to 2 hours per dayfor 8 weeks. The indomethacin group wastreated with indomethacin (25mg) for 4weeks (unequal treatment time). The clinicalobservation of the symptoms checklist andblood test results showed that significantlymore patients in the qigong group reportedgreater improvement when compared to theindomethacin group, 83.3% vs. 56.7% (P<.01). In the qigong group, 75% of patients’ESR decreased to normal, while just 42.1%of the indomethacin group did so. In termsof the rheumatoid factor, 79.1% of the casesin the qigong group were negative, com-pared to 47.6% of the cases in theindomethacin group. In addition, there wereno side effects reported in the qigong group,while the patients in indomethacin groupreported abdominal distension (16.7%), nau-sea (7%), stomach ache (27%) and bleedingin the digestive system (7%). Results fromthis study suggest that qigong therapy mightbe more effective than indomethacin fortreating rheumatoid arthritis.

Yuan et al. (33) treated radicular cer-vical spondylopathy with qigong therapy in44 patients who met the criterion establishedby the Second National Conference ofCervical Spondylosis. The patients were ran-domly assigned into a qigong treatmentgroup (N = 26, qigong plus Chinese herbaltherapy) or the control group (N = 18, treat-

ed with Chinese herbal therapy alone).Subjects in the treatment group practicedThe Shanghai Eight-Step qigong and mind-induced relaxation exercise twice daily (30 -40 minutes each time), in addition to receiv-ing the same Chinese herb as the controls.The Therapeutic Efficacy Criteria of ClinicalTrea tmen t by the Ch inese Hea l t hDepartment of the Army was used for diag-nosis and evaluation of treatment efficacy.After 30 days of treatment, the clinicalimprovement was much greater in theqigong treated group than in the controlgroup (P <.05). Furthermore, there wasgreater improvement in the blood rheologyindexes (including high-sheer viscosity, low-sheer viscosity, aggregation index of redblood cells and stiffness index) for the treat-ment group than for the control group (P<.05). The researchers concluded thatqigong therapy had a significant effect overand above the herb alone on radicularspondylopathy, and that the mechanism ofqigong therapy for this condition probablyresulted in the improvement in blood rheol-ogy.

Lu (34) conducted a double-blindrandomized control trial to examine theeffect of massage combined with qigongtherapy on cervical spondylosis. Ninety-twopatients with cervical spondylopathy (aged16 to 72 years; diagnosed by symptom andcervical vertebrate x-ray) were randomlyassigned into three groups: the qigong group(N = 44), the massage group (N = 30) andthe combined group (both massage andqigong, N = 28). Neck and nape qigong waspracticed by the designated group twice perday, for about 30 minutes each time. Themassage therapy involved a process of localrelaxation, rotation reposition and tractionmanipulation. The treatment effect was eval-uated with the Chinese criteria set up by theNational Congress of Cervical Spondylosisin 1984. The average numbers of treatmentswere 13.7 for the combined group, 19.6 for

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the massage group and 28.3 for the qigonggroup. The final results showed that 94.4%of patients in the combined treatment groupreported significant improvement, muchhigher than the proportion in the qigong onlygroup (64.3%; P <.01) and the massage onlygroup (70%; P <.05). The researchers con-cluded that the massage combined withqigong practice is better than massage orqigong alone for treating cervical spondylo-sis.

Huang et al. (35) conducted a similarclinical trial to compare the effect of qigongplus massage to massage therapy alone fortreating cervical and scapulohumeral peri-arthritis. In their study, 100 patients (aged 22to 70 years) with either cervical spondylopa-thy or scapulohumeral periarthritis wereevenly split and assigned to one of twogroups: the qigong group (21 males and 29females) or the control group. Each groupconsisted of 24 patients with cervicalspondylopathy and 26 patients with scapulo-humeral periarthritis. The qigong groupreceived qigong plus massage every otherday for 15 to 20 minutes each session, andfor 6 to 12 sessions in total. The controlgroup received massage only for the samenumber of sessions. At the end of the treat-ment, the qigong group had 22 subjects(44%) reporting a complete cure, i.e., allsymptoms had disappeared and joint func-tion was normal. Nineteen subjects (38%)showed significant improvement, i.e., swel-ling and pains were greatly ameliorated andjoint function was much improved. Eightsubjects showed some improvement, andonly one subject showed no effect. The cor-responding numbers (in %) in each categoryof the control group were 10 (20%) reportingcomplete cure; 16 (32%) showing signifi-cant improvement; 17 (34%) showing someimprovement; and 7 (14%) showing noeffect (Chi-square = 9.41; P <.05).

These studies suggest that qigongmight provide significant pain relief for

arthritis patients (23-35). There is urgentneed for more sophisticated clinical trialswith appropriate controls. Patients treatedwith qigong therapy have achieved completecures according to Chinese clinical criteria.These reports motivated us to explore theeffectiveness of qigong therapy. The follow-ing are the results of a preliminary open trialapplying EQT in our clinic to treat chronicarthritis.

An Open Pilot TrialAn anecdotal pilot study of EQT for arthritiswas undertaken to collect preliminary data.This pilot was designed as an open trialwithout a control. The study was anecdotalwithout pre-scheduling due to the tightschedule of the qigong healer when he visit-ed the US for a short time.

SubjectsThe Institutional Review Board of theUniversity of Medicine and Dentistry ofNew Jersey (UMDNJ) approved this openpilot trial. The informed consent explainedthat qigong is a form of traditional Chineseenergy medicine, but is not an approvedtreatment in the US. Ten patients with chron-ic arthritis pain (constant or daily) wererecruited from a private rheumatology prac-tice on the day of the study to participate inthis open pilot trail. Nine participants wereCaucasian, and one was Asian. The meanage was 58 years (ranging from 20 to 76),with seven females and three males. Foursubjects had osteoarthritis of the knee and/orhip and one had osteoarthritis of the hands.Three patients had osteoarthritic spondylo-sis, two had rheumatoid arthritis, primarilyof the upper extremities, and one hadspondyloarthropathy. All expressed someconfidence in complementary and alterna-tive medicine (CAM), but only two had usedCAM previously and just three had heard ofqigong prior to the study.

The duration of pain ranged from 2

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months to 20 years (mean = 6.1 years). Fivepatients were married, three widowed andtwo had never married. Six patients reporteda family history of chronic pain. Eight con-sidered themselves to be religious, six hadprayed for their health and four had meditat-ed for health purposes.

ProtocolAfter informed consent was obtained, thepatients completed a short questionnaire andwere examined by a rheumatologist to con-firm the diagnosis within the criteria set bythe American College of Rheumatology (36-38). The patient was then seated in a quiettreatment room with the qigong healer (whodid not speak or understand English) and atranslator. Treatment consisted of the qigonghealer administering qi emission for 5 to 10minutes, with the duration determined by thehealer’s perception of qi blockage. Thepatient was touched from time to time to pin-point and lightly massage the pain area. Attimes the healer uttered words in Chineseclimaxing in a shout, representing a dis-charge of strong qi. After that, the healerused his hands to induce the sick qi out ofthe patient’s body from the bottom of thefeet or the fingertips.

Treatments were given on 3 consecu-tive days. Two subjects could not come backfor the follow-up treatment due to schedul-ing conflicts, and two dropped out after thesecond treatment without giving a reason.Thus, six of the original 10 subjects com-pleted all three treatments, completed evalu-ations, and were followed-up 1 month aftertreatment was concluded. The low comple-tion rate was mainly due to the recruitmentprocess, which did not allow for prior con-tact to establish the feasibility of scheduling.

MeasuresThe measurements used to evaluate improve-ment included visual analogue scales (VAS)for: pain (a 100mm line with verbal anchors

of "no pain" and "the worst possible pain"),mood (anchored by "the best I could feel"and "the worst I could feel") and relief(anchored by "no relief of pain" and "com-plete relief of pain"). Additional scalesincluded an instrument of physical disability(39) (10 items of daily activity); theSpielberger State-Trait Anxiety Scale (40)(state part only, 20 items); and a categoricalpain scale (41) (eight verbal descriptors from"no pain" to "excruciating"). The same rhe-umatologist performed a swollen/tenderjoint count for all patients at each visit.

ResultsComparison of VAS pain, as well as moodand relief scores in the 10 subjects immedi-ately prior to and after the first treatmentshow that most subjects experiencedimprovement (Table 1). Nine subjectsreported a reduction in pain (mean reduction= 30, SD = 23) and 8 reported mood im-provement (mean reduction = 21.5, SD =17); one subject reported contradictoryresults: more pain on the VAS, but reducedpain using the verbal descriptors. Two sub-jects reported "no-pain" in the categoricalpain scale after the first treatment. Subjectsreported various degrees of relief after thefirst treatment (mean = 63.7 and SD = 25).

Using non-parametric statistics totest the difference between positive (painreduction) and negative response (painincrease), in nine out of 10 trials the patientsreported reduction in pain. This could occurby chance only at P <.01 in a cumulativebinomial probability distribution.

Only six of the 10 subjects complet-ed the protocol due to scheduling difficultiesand other unexplained reasons. Table 2 pres-ents the results of VAS pain, mood and reliefscores at the four time points of the study forthe six completed cases. After the third treat-ment, all six subjects still reported reductionin VAS pain, ranging from 11 to 62 (meanreduction = 34.7), and increased relief

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ID # Major Diagnosis

Pain Negative Mood VASRelief

Prior After Change Prior After Change

1 Lumbar spondylosis 87 72 -15 18 12 -6 76

2 RA 49 35 -14 46 53 +7 55

3 OA-at hands 72 18 -54 54 20 -34 81

4 Cervical spondylosis,fibromyalgia

75 47 -28 53 47 -6 14

5 Lumbar spondylosis 14 32 +18 50 38 -12 74

6 OA at knee 49 4 -45 50 4 -46 49

7 OA at knee amd feet 84 21 -63 16 0 -16 100

8 Spondyloarthropathy 58 32 -26 56 30 -26 61

9 OA at feet & hands,CREST syndrome

11 2 -9 45 19 -26 87

10 RA on the back 51 35 -16 27 32 +5 40

Mean 55.0 29.8 -25.2 41.5 25.5 -16.0 63.7

Table 1. VAS pain, mood, and relief score measurements made immediately prior to and after thefirst treatmentOA = osteoarthritis; RA = rheumatoid arthritis; CREST = Calcinosis, Raynaud’s phenomenon,Esophageal motility disorders, Sclerodactyly and Telangiectasia



scores; five of the six reported reduced neg-ative mood scores. At the 1-month follow-up, two subjects (both with osteoarthritis)reported persisting complete relief, althoughothers reported a slight increase in pain incomparison to the measurement immediate-ly following treatment.

Four of the six subjects had reducedactive pain/ tender joints, by as much as 26points, immediately after treatment; one hadno change and one had slightly more activepain/ tenderness in the joints (Table 3); at the1-month follow-up, four of the six subjectshad a reduction in pain/ tender joint count.There were two non-responders; subject 5

with lumbar spondylosis and subject 10 withrheumatoid arthritis.

In immediate post-treatment meas-urements, movement difficulty was reducedin four subjects, was unchanged in one androse slightly in one. At the 1-month follow-up scores in all subjects had diminished by amean of about 50%; the subject with CRESTand osteoarthritis reported no difficulty inmovement, concordant with her report ofcomplete relief and no pain at follow-up.

The Spielberger Anxiety Scaleresults demonstrated a reduction in anxietyafter qigong treatment in all subjects.

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ID # Pain Negative Mood Relief

T0 T1 T2 T3 T0 T1 T2 T3 T1 T2 T3

3 72 18 10 12 54 20 6 16 81 92 88

5 14 32 1 5 50 38 13 12 74 99 84

6 49 4 0 21 50 4 0 11 49 100 68

7 84 21 24 0 16 0 10 5 100 56 100

9 11 2 0 0 45 19 6 0 87 98 100

10 51 35 38 37 27 32 31 50 40 74 52

Mean 46.8 18.7 12.2 12.5 40.3 18.8 11.0 15.7 71.8 86.5 82.0

Table 2. VAS pain, mood, and relief scores prior to and after the first and third treatment, and atthe 1-month follow-upNote: T0 = before treatment; T1 = After 1st treatment; T2 = after 3rd treatment; T3 = 1-monthfollow-up after the treatment.

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DiscussionOur literature review suggests that qigongtherapy might provide significant improve-ment for patients with various arthritis con-ditions. The positive reports in the Chinesemedical literature invite more clinical stud-ies of this ancient therapy for treatment ofchronic arthritis, and encourage us to rethinkthe etiology of arthritis. However, improve-ment in experimental design is needed withmore sophisticated clinical trials to confirmthese intriguing results. The literature onboth qigong and acupuncture suggests thatbioenergy-based therapies might be moreeffective than conventional Western medi-

cine for treating chronic conditions such asarthritis.

There are significant limitations inmany of the reviewed studies. First, Chinesemedicine classifies arthritis differently fromWestern medicine, and there was a lack ofconsistent diagnosis and evaluation criteriain China. Second, most studies lacked com-patible control groups, especially the place-bo-control, making their results subject tosuggestibility or placebo effect to anunknown degree. Third, although qigongtherapy is relatively popular in Chinese hos-pitals, there is no standard procedure thatcould be agreed upon by different practition-

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ID# Active pain/tender joint counts Physical disability scores Anxiety state sore

T0 T2 T3 T2-T0 T3-T0 T0 T2 T3 T2-T0 T3-T0 T0 T2 T3 T2-T0 T3-T0

3 38 12 37 -26 -1 10 6 8 -4 -2 28 22 28 -6 0

5 11 10 22 -1 +11 10 12 5 +2 -5 38 27 22 -11 -16

6 14 5 1 -9 -13 15 5 13 -10 -2 43 29 31 -14 -12

7 8 8 5 0 -3 10 10 3 0 -7 29 27 23 -2 -6

9 13 2 0 -11 -13 13 7 0 -6 -13 41 Miss 20 -21

10 14 23 24 +9 +10 8 3 6 -5 -2 51 50 35 -1 -16

Mean 16.3 10.0 14.8 -6.3 -1.5 11.0 7.2 5.8 -3.8 -5.2 38.3 31.0 26.5 -6.8 -11.8

Table 3. Total Pain/Tender Joint Counts, Physical Disability Scores and Spielberger State AnxietyScale Scores prior to and after the treatment, and at the 1-month follow-up.Note: T0 = before treatment; T2 = after three treatments; T3 = 1 month later.



ers or healers, which makes it very difficultto implement the therapy in standard clinicaltrials and service. Future studies should takethese points into serious consideration.

Our preliminary open trial was desi-gned to explore the pain-relief effects of qi-gong therapy for Western arthritis patients.Our results indicate that, like many alterna-tive therapies, EQT provided some painre-lief for most of our participants. The patientswho completed all three treatments reportedsome improvement in pain and anxiety, aswell as improvement in active pain /tenderjoints, and two of the participants continuedto report complete resolution at the 1-monthpost treatment follow-up. The positive resu-lts in both the Chinese studies and the anec-dotal pilot study demand further examinationof qigong therapy for treatment of arthritis.

It is time to ask: How can we expandour knowledge of qi and bioenergy in thearea of human health and disease? How is

bioenergy related to chronic pain such asarthritis? We are confronted with the chal-lenge that a well-controlled trial of EQT isdifficult to design and implement. Qigongtherapy requires interaction between thetherapist, here the qigong healer, and thepatient, in essence like psychotherapy.

Sham healers have been employed inqigong studies using animals and cell lines(7,10). Utilizing sham healers is more diffi-cult in human studies given the confidenceand strong presence the master exudes. Mo-tivated by our results in the preliminary opentrial we are proceeding with a more defini-tive trial of EQT for treating arthritis. Wehope other clinical studies will be conductedto explore the therapeutic effects of qigongtherapy on various arthritis conditions.

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ANAOMY/PHYSIOLOGY



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effect of qigong on arthritis

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