Interdisciplinary approach to qigong - scientific study on principle of healing by qigong

I . Introduction
Qigong which has spread all over the world as a method of treating or preventing diseases and promoting health is one of fields of Traditional Chinese Medicine (TCM), and has been established on the same fundamental theory or the same principle of clinical effects as acupuncture and herbal medicine. It is no exaggeration to say that the questions such as 'what is Qi?' or 'what is Qigong' might be same as to ask 'what are human being?' Thus, considering Qigong as a 'medicine of Qi' in a broad sense, we tried to reveal the mechanism of clinical effects in TCM including Qigong through scientific approach .

II . Methods through interdisciplinary approach
Such methods as image engineering and multivariant statistical analysis are necessary when extracting information suitable for objective verification firm the classical documents of oriental medicine and making it understandable on a modem scholastic basis. Multivariant statistical analysis is a scientific method that challenges vagueness and complexity which have troubled conventional medical spheres. Image engineering is a method which enables us to measure images difficult to measure with an ordinary means.

Subjects were 200 persons in total, consisting of healthy adult volunteers and patients with various diseases. Methods such as examination of the literature, neuro science, nuclear medicine, image technology and metric medicine were used for scientific approach to principle of clinical effects of Qigong to perform comprehensive analysis and discussion.

III. Scientific of theory of qi through philological approach

(1) Method
An attempt to schematize the pathology of TCM and the principle of Qigong was performed through philological approach using field science techniques. The philological approach means a study to reveal the substantial components of TCM through examinations of medical classics from various aspects. Field science is an excellent study method to deal with problems on the field which involve a lot of mutually related factors and are likely to change, and it has been applied to solving of complex problems and used as a scientific method with tests of hypothesis.

(2) Results and Discussion
Philological study of the literature on Qigong allowed us to schematize principle of Qigong. Qigong is a self training for promoting physical and mental health through production and accumulation of Qi, and distribution of Qi via meridians to the whole body. Qigong has its base on the regulation of body (Posture), the regulation of breathing (Respiration) and the regulation of mind (Mind-will). One attains the self-control of physical functions through the regulation of body and breathing (Posture and Respiration), after then attains the self-control of mental conditions through the regulation of mind (Mind-will). These lead to the realization of the goal of the TCM, that is, 'the integration of body and mind' and 'Fu Zheng' (strengthening the body resistance), which characterizes Qigong. Master of Postures, Respiration and Mind-will produces a well-balanced body functions, and makes it possible to regulate Jing, Qi and Shen which are indispensable for maintaining the life, and to improve the innate Healer within. In such an occasion, since Qi in the body (inner Qi) circulates the meridians, various types of Qigong practices make importance of the relationship between Qi and meridians, and make it the predominant objective to allow smooth flow of Qi through meridians .

In 'The Yellow Emperor's Cannon of Medicine,' it is stated that a shortage or stagnation of 'Qi' (vital energy), or an imbalance of Yin and Yang can cause diseases. It is also emphasized that the fundamental principle of therapy is to attach importance to 'Shen' (the spirit) during diagnosis and treatment and 'to Control Shen. The 'Shen' is a general term for life activities, but it also refers tot he functions of the cerebrum. In the old Chines medical books, Shen is explained as a sign of Qi and in close relationship to Qi.

Qigong has placed emphasis on Lian Shen (training of Shen), Zan Shen (training to remove any thought from one's mind) and Shou Shen (concentrations of one's attention), and recognized and realized the importance of Shen (the spirit) from old times. Examination of the literature such as, among others, 'The Yellow Emperor's Cannon of Medicine' revealed that 'Control Shen' (the spirit) is the fundamental principle of Qigong and acupuncture therapy. 'Control Shen' is the key concept of TCM, which suggests that it is the most important element for clinical effectiveness of therapy to control functions of the brain as the center of the Healer Within (inner Qi) both in mental and physical aspects.

Thus we consider 'Control Shen' as the principle of healing in acupuncture and Qigong therapy, and conduct a comprehensive study through interdisciplinary approach.

IV. Scientific principles of healing with qigong (control shen through interdisciplinary approach

(1) Scientific 'Control Shen' through neurophysiological approach.

Subjects and Methods
1. 30 Adult Subjects in Total Including Healthy Adult Volunteers and Patients with Various Diseases.
They were treated with Qigong and electric acupuncture both of which are typical therapies of TCM. The method used as Qigong therapy was Relaxation Qigong which is well known as a representative of Inner Qigong. The site of stimulation in electric acupuncture was C04-C010. Electric stimulus with frequency of 2-3 Hz was applied for 10-20 minutes at a level of intensity which caused slight local muscle contraction. Measurement was done using EEG topography. EEG topography was performed according to the ten-twenty electrode system. Unipolar EEG records at 12 sites of the scalp were processed by an EEG topography system (NEC/Sanei Electric); to obtain topograms before, during and after stimulation.

Results and Discussions
1. Effect of Inner Qigong on EEG Topograms in Representative Cases. Before applying Qigong, power was prominent in the alpha-l band zone. After applying Qigong, an increase in power was observed in the alphy-l band zone from the right temporal to frontal region, and a tendency was shown to activate the right brain.
2. Effect of electric acupuncture on EEG topogram (in representative cases)
As shown in EEG topograms for various regions following stimulation of right IC4 - IC10, the power of alpha waves (in particular the alpha-1wave) in the entire cortex of chiefly the parietal region increased markedly after stimulation, and this tendency lasted for 15 minutes after stimulation. In these EEG topograms an increase in power was visible not only in the alpha wave but also in the theta wave of the parietal to frontal region.

A general assessment of EEG topograms revealed that their response following acupuncture stimulation could be divided into two types: an increase in alpha wave power and an increase in the power of theta and alpha waves. All subjects perceived the stimulation as being comfortable. The power increase in the alpha and theta waves is generally regarded as a sign of mental relaxation. To our interest, this finding is akin to the brain wave pattern of meditating prieses [?] reported by Hiral et al. of Tokyo University.

(2) Scientific 'Control Shen' Through Nuclear Medicine
1. Subjects and Methods
Subjects were 30 adults in total including healthy adult volunteers and patients with various diseases. They are treated with electric acupuncture which is a therapy of TCM. The site of stimulation in electric acupuncture was Co4-Co10. Electric stimulus with frequency of 2-3 Hz was applied for 10-20 minutes at the level of intensity which caused slight local muscle contraction. Measurement was done using Positron CT (PET). Position CT is an apparatus by which the distribution of radioactivity within a target organ is determined (utilizing the characteristics of annihilation), visualized and analyzed following the injection of radioisotope-labeled positron-emitting radionuclide. In the present study, we performed qualitative PET analysis using 11C-CO2 and 11C-glucose and quantitative PET analysis using 1502 and C1502. The apparatus used for data collection was a Shimadzu Headtom II. After designation a region of interest (ROI) in the brain using an image analyzer for acupuncture, the position CT images before and after stimulation were analyzed.

2. Results and Discussions
Analysis of positron CT images disclosed a post-stimulation elevation of nerve cell activity in the thalamus and the cortex on the side opposite the stimulated side. In addition, electrical acupuncture temporarily potentiated both neo- and paleocortex, chiefly in the frontal region, resulting in the correction of biased regional cerebral blood flow.

The following finding from the present study suggest the applicability of the A10 nerve theory, which was developed from the conventional theory of the activating system: (1) the finding of Fm(theta) on EEG topograms, (2) a PET finding of elevated nerve cell activity over a wide area from the frontal to temporal region (including the thalamus), and (3) a feeling of comfort experienced by subjects following acupuncture stimulation. Qigong, acupuncture therapy, meditation (Zen) therapy and Yoga, are all considered Oriental methods of therapy. The fundamental principle common to these Oriental methods is the activation of 'Inner Qi' (vis medicatrix naturae) through influences from body to mind' to regulate both physical and mental functions.

It seems likely that the de-qi of acupuncture and Qigong potentiate the Al0 nerve, settle the fiction between the neocortex and paleocortex, control autonomic nervous function, and activate homeostasis at the brainstorm level.

(3) Scientific 'Control Shen' Through Psychoneuro-Immunological Approach

1. Pathology of 'The Yellow Emperor's Cannon of Medicine' and Psychoneuroimmunology (PNI): Philological study of 'The Cannon of Medicine' revealed us a pathological theory that the seven emotional factors (psychological factors) play an important role in development and course of diseases. A new interdisciplinary science which scientifically proves the universal validity of this pathology is psychoneuroimmunology (PNI) . Psychoneuroimmunologists have revealed that immunocytes and the brain (mind) control each other and there is an interaction between them which produces relationship between body and mind. PNI proposes an theory that Healer Within or Hen Qi (body resistance) consists in the close and essential relationship among mind, nerves, internal secretion and immunological system. The system theory in TCM corresponding to above mentioned theory is Jing/Qi/Shen.

2. Subjects and Methods
Subjects were 16 patients aged 66 to 94 (average: 79 years old). All were patients with complications including arterial sclerosis, hypertension or postapoplectic sequelae. The following immunological parameters were measured: cellular ratio of OKT3 + , OKT4 + and OKT8 + as subsets of lymphocytes in the peripheral blood; cellular ratio of Leull + as a subset of NK cells; and, PHA, Con-A and PWM as blast transformation reaction of T lymphocytes in the peripheral blood.

Meridian points which have proved to be effective for health preservation and rehabilitation from the old time were selected as the stimulation points. Subjects were treated with acupuncture therapy twice a week for two months. Blood samples were collected from the forearm just before the start of treatment and at the end of treatment and were subjected to immunological measurement and analysis.

Results and Discussions
1. Cellular ratio results of OKT3+ before and after treatment was 63.9 +/- 8.9% and 73.3 +/- 9% respectively. They showed a significant increase (p < 0.01). Cellular ratio of OKT4 + before and after treatment was 4.2 +/- 5.1-% and 45.0 +/- 9.0% , respectively, which showed a significant increase (p< 0.05) . OKT4 + /OKT8 + ratio showed a slight increase.

2. In terms of blast transformation reaction of T lymphocytes, all of PHA, Con-A, and PWM showed a significant increase after the treatment.

3. Cellular ratio of Leu II+ as a subset of NK cells showed a slight increasing tendency.

4. After acupuncture treatment, both physical and mental subjective symptoms were decreased,
with improvement in appetite, sleep, defecation, and fatigue. The main subject of PNI is 'the interaction of mind and immunity,' and it bases its principle on the concept that 'every disease from cold to cancer involves any psychological factor in its onset.'

S.E. Locke et al. showed based on the objective data that 'Healer Within (Inner Qi)' can work in the close relationship between mind, neuroendocrine system, and immune system, and that the human 'heart' or personal situation factor plays a great role in human healing. S.E. Locke said that the excess symptoms and signs of the healing system would be synonymous with those of 'fu-zheng'; is the activation of healthy energy in TCM. However, he does not understand that the key of the Oriental approach to gain 'fu-zheng', the activation of healthy energy is 'Control Shen (spirit), which is valued highly in classical texts.

(4) Scientific 'Control Shen' through Metric Medicine Clinical Significance of 'Control Shen'

'Control Shen' in the old books has two points: (1) when the therapist sincerely conducts acupuncture therapy, this leads to a desirable doctor-patient relationship and causes the Qi of the disease to work well, and (2) the de-qi of acupuncture and Qigong has the effect of regulating Shen and Qi, and can regulate life and the nourishing energies .
We decided to investigate 'pain', a condition with a close relationship with the function of 'life and nourishing energies) and 'Shen'. We tried both the psychosomatic medical approach and the metric medical approach for the purpose of a scientific study of Control Shen.

Subjects and Methods
The subjects consisted of 59 patients who were out-patients of the Osaka Medical College Pain Clinic. These patients were given the Questionnaire on Pain with 124 items, and consequently, they were classified into 2 groups: the acute pain group and the chronic pain group. Chi-square test was conducted regarding the numbers of each item counted and the input data were secured for 21 variables which showed significantly high level.

Results and Discussions
1. A factor analysis was conducted and 7 latent factors were obtained including; the factors, I) the personality of the patients ,II) the therapy that has direct effects on the pain reaction, III, IV and V) the pain reaction, VI) the therapist-patient relationship, and VII) the pure pain.

2. A structural figure of pain complaints and a model theory of pain This is the structural figure of pain complaints based on the factor loading, with the criterion of eigen value over 2 obtained from the varimax rotation. When the factor loading of 21 variables are arranged as points on the two dimensional space, four groups of gatherings are found on it; (A) the site of pain, (B) pain reaction and a treatment technique directly related to the reaction, (C) the personality of the patients with pain, and (D) the situation including the doctor-patient relationship and environmental factors. 3. A theory model of pain has been established based on the seven common factors obtained from the factor analysis and the structure figure data of the 21 variables, and by adapting the various pain theories of modem medicine and the etiology of 'The Yellow Emperor' s Cannon of Medicine'. This theory model of pain is that of the 'Control Shen'.

In this theory, human pain is considered to be a complex pattern of the originating sensation and the pain reaction. Pain control, including acupuncture, acts on the pain reaction, a psychological reaction (the action of Shen and Qi). This mental reaction causes physical reactions (the reactions of the autonomic nervous system and the reactions of the skeletal muscles) . The personality and the life history of the patient, as well as his/her attitude toward pain, are closely related to the degree of pain felt. Its therapeutic effect is much influenced by 'the space' composing of the interaction between doctors and patients and the various factors surrounding patients, and analgesic and anesthetic action (effect of 'Control Shen') works involving with all of those situation factors of 'the space'.

The application of this theory model makes it understandable that a similar therapeutic effect may be ultimately expected regardless of the method used for treatment. Pain is a typical stress-related Symptoms both in body and mind. The ancient Chinese people had recognition that not only the originating sensation (pure sensation) but also the emotion (the seven factors of Internal causes of sickness) affect the physical functions, which leads to the pain reaction. In 'The Yellow Emperor' s; Cannon of Medicine,' the mechanism in which Shen and Qi affects the pain was described and the 'Control Shen' was considered to be the key to success of the acupuncture therapy.

The theory model of the pain (the theory model of Control Shen) can comprehensively explain all of the leading pain theories of the modern medicine as well as to resolve the fundamental principle of the healing.

V. Conclusion
Through making the model of Control Shen theory, the principle of therapeutic effects of Oriental medical approach including Qigong, acupuncture, herbal medicine, therapy through Zen, and Yoga could be explained.