Qigong treatment of hypertension: a systems approach to qigong therapy

Author: Song Zhiying//Fong Kiatong//Schwartz Gary E
Conference/Journal: 4th Intl Conf on Qigong
Date published: 1995
Other: Pages: 5-9 , Word Count: 2453

Qigong is an ancient philosophical system of harmonious integration of the human body with nature. The basic principle of qigong is to coordinate the human body with nature and the universe. It integrate diverse disciplines and techniques - mentally, morally and physically. It is believed to be the most ideal way to treat disease and acquire longevity and happiness. The purpose of this paper is to present a comprehensive, systems approach which synthesizes nine major theories of biofeedback from the micro to the macro to help explain qigong. Qigong can be regarded as an extension of biofeedback because of its focus on self- regulation. However, qigong emphasizes the mind's regulation and the cultivation of morality in both social relations and the environment which extends it beyond simple framework for understanding and integrating diverse approaches within qigong across every level. Hypertension is a prototypic whole body disease with dysfunction and potential organic pathology in multiple organ systems. Its etiology is still not completely clear and its mechanisms are very complicated since it reflects a synthesis of multiple factors. Up to now there have not been very effective treatment methods, and current methods often have negative side effects. The qigong approach to the treatment of hypertension can be used to illustrate a systems approach to qigong's effect in general. Although different'Gong methods' have been used, all have been reported to have large effects in reducing blood pressure and other physiological phenomena. Data from qigong experimental research in China demonstrates qigong's positive effects on almost every lie process form the physical ideal way to achieve health, longevity and a happy life.


Qigong is an ancient philosophy and practice involving the harmonious integration of the human body with the universe. It is believed that this approach to improving and maintaining health has existed for more than 5000 years. Systems theory is a modem scientific approach which was developed in the past 50 years. It turns out that many of the principles in qigong theory are very similar to concepts in systems theory. In fact, we propose that systems theory can be used to help explain many qigong phenomena. The purpose of this paper is to illustrate how systems theory can be used to understand and explain qigong theory and practice.

First, we will briefly review key concepts of systems theory and illustrate how they are related to key concepts in qigong theory. Then, we will focus on one major component of systems theory, termed feedback, and illustrate how a 9 level systems approach to feedback can be directly applied to 9 levels of qigong processes. Finally, we will illustrate how these concepts can be used to help us understand why a qigong approach to hypertension may have large clinical effects.

Introduction to Systems Theory

In his book, LIVING SYSTEMS THEORY, Miller (1978) has stated that a system is: 'A set of interacting processes with a relationship among them. The word 'set' implies that the units have some common properties. These common properties are essential in that the units interact or have relationships with one another. The state of each unit is constrained by, conditioned by, or is dependent upon the state of the other units.' (Miller, 1978).

The potential to function as an organized whole underlies the concept of a system. There are at least two basic requirements for a system to exist and function as whole: the components must be connected, and information between components must be transmitted and processed accurately (Schwartz, 1984). Schwartz (1991) has proposed that there are two fundamental hypotheses for systems science. The first is the Universal Structure Hypothesis which purposes that everything in the universe shares some common forms or structures. The second is the Universal Connection Hypotheses which proposes that all levels within the system and outside the system are directly or indirectly connected with each other and therefore directly or indirectly influence each other.

A common property in systems is that connection leads to self-regulation which is expressed as order or rhythms in the system. These orders or rhythms typically occur automatically with a relative degree of ease. Living systems are open to receiving matter, energy and information. Schwartz (1984) has illustrated how self-attention and the voluntary control of awareness can enhance connectivity within systems.

Applications of Systems Theory to Qigong

According to qigong theory, the fundamental philosophy for qigong practice is the view that 'Human Life is a Holistic Entity'. This indicates that the universe is a holistic entity - a macro system. Everything in the universe is initiated from qi - so called 'yuan qi' or'essential qi' - which can be divided into two basic properties - yin qi and yang qi. The basic principle for universal movement is keeping balance between yin qi and yang qi. It is believed that only through the alternation of yin qi and yang qi do things come into existence and evolve, from micro systems to macro systems. According to qigong, all things in the universe are related. They influence, restrict and change each other, combining and forming new functional entities. Human beings are seen as specific entities or 'states' in the universe, a concept very similar to the concept of 'systems'. Hence, humans are systems composed of yuan qi, including yin qi and yang qi.

Human functioning (including behavior) is determined by external factors (social and natural) and internal factors (e.g. organ systems). According to qigong, humans should synchronize their activities with both the social and natural environments and simultaneously regulate the functioning of their internal organ systems or subsystems. It is believed that the regular practice of qigong creates a special state for achieving synchronized functioning across levels.

The most basic principle for qigong practice has been called the 'Cultivation of Morality and Adjustment of Mind'. (Yan, 1989). Morality cognitively and emotionally connects human beings with their environment. Through these connections, humans can establish a healthier relationship with their environment. They can gain more information from society and nature in order to help them better fit with the environment.

The healthy human body is believed to be similarly connected and coordinated. All internal systems are believed to be working together and functioning as a whole entity or system through the alternation of qi following the well known 'Five Element Theory' (Lin C, 1990). It is believed that the alternation of qi required for all levels of connection and information transfer. It is hypothesized that qigong practice can help establish and enhance internal and external communication through specific voluntary training. This practice can increase the ability of mind to control qi and the body automatically.

There are three major components for the practice of qigong - mind regulation, breath regulation, and body regulation. Mind regulation is believed to be the core of qigong practice, where as the other two components, breath and body regulation, are seen as methods for helping the regulation of mind. Note that in qigong the concept of mind has a wide meaning, from the nervous system, through subconscious and conscious processes, to the understanding of old and modern philosophies and experiences. As a result, qigong regulation is viewed not only at physiological levels, but at higher psychological and social levels as well.

It follows that is possible to interpret qigong science as reflecting a complex holistic system at multiple levels. Since systems theory has the potential to help organize and synthesize information across various levels and disciplines, it provides us with an organizing structure to help us tease apart complex interactions that can occur at multiple levels within and across systems. Systems theory can help us better understand this tremendous complexity and help explain why and how qigong practice may be so useful for promoting and maintaining health.

Nine levels of biofeedback and qigong

Schwartz (1984) has proposed that biofeedback can be viewed as a systems concept that operates at multiple levels in nature. Generally, biofeedback includes two types of feedback- negative and positive. Typically, a living system contains various combinations of negative and positive feedback loops (Miller, 1978) that enable self-regulation to occur. It is believed that biofeedback has important paradigmatic implications for health care and health promotion since it can facilitate self-regulation at multiple levels, from biological through psychological to social levels.

Negative and positive feedback both promoted self-regulation. When the feedback between parts of a system are connected, the system will regulate itself in particular ways, either balancing the system (negative feedback) or exciting the system (positive feedback). A useful diagram of biofeedback is shown in the following simplified figure (see Figure 1).

Using concepts from systems theory, Schwartz has synthesized nine major approaches or theories of biofeedback as reflecting nine different levels of biofeedback processes. Schwartz illustrates how the different theories focus on different processes that occur at different levels. They are depicted in Table 1.

Organizing the nine theories in this fashion illustrates how biofeedback can involve low level, homeostatic, cybernetic self-regulation and high level, cognitive, modulation of these cybernetic processes. Moreover, the higher level cognitive processes may modulate the more basic biological processes even though subjects may not be consciously aware of these processes or that these processes are changing.

Level 1 cybernetic self-regulation involves virtually no learning. However, if the feedback system has the potential for conditioning, learning can be added to the cybernetic loop as illustrated in Levels 2 and 3, classical and operand conditioning. Hence, the behavior of the self-regulated systems can change as a function of experience. Whereas conditioned self- regulation effects can occur automatically, learning more complex motor and cognitive skills (levels 4,5 and higher) requires more complex feedback information and requires more practice. Once the skills have been learned, the skills can be maintained with regular practice and reinforcement.

An essential component of biofeedback learning involves the ability to detect interceptive feedback of physiological activity. Awareness of cognitive, affective and somatic processes that are correlated with the desired physiological changes involve higher level biofeedback learning. It has been proposed that biofeedback can be used to help patients learn to recognize and control key risk factors that contribute to physical health and illness (Schwartz, 1984). Hence, biofeedback can help therapists and patients select the most effective clinical strategies for reducing excessive physiological response by learning to control specific thoughts, feelings and behaviors at Level 6 that directly or indirectly contribute to physiological disregulation (Schwartz, 1984).

It is important to teach patients to correctly interpret the feedback in a healthy fashion. It has been hypothesized that this can facilitate neuropsychological reconnections leading to enhanced self-regulation. Promoting self-education and insight at level 7 may facilitate patients thinking more integratively about mind-body-behavior-environment connections (Schwartz, 1984).

In addition, biofeedback can have an effect on a person's motivation and can lead to fundamental changes in self-concept and attitudes which may have side-ranging effects on a person's life style. This level 8 learning not only increases a person's ability to maintain self- control, but increases a person's general sense of self-efficacy enabling them to feel happier, more hopeful and more energized. finally, level 9 biofeedback can help people learn social styles that can promoted biological and psychological health. Styles of social interaction can effect not only an individual's physiology, but the physiology of the people they interact with a_ well (Schwartz, 1984).

When qigong theory and practice is viewed in terms of biofeedback from a systems perspective, it becomes clear that all nine levels of theories are involved. Our analysis will begin at level 9 and move down to level 1. First of all, qigong can be viewed as a level 9 social process that benefits from social practice. It strongly emphasizes the relationship among human beings and between human beings, nature and society. Qi is believed to be the communicating bridge between all the levels. Also, the cultivation of morality and the regulation of mind can been seen as kinds of attention training, including social, psychological and biological levels (levels 9 to 1). With continued practice, the qigong practitioner will have a stronger sense of morality and an enhanced ability to control mind and promote health.

Moving down levels, qigong training is associated with increased sense of self-control, self- efficacy (level 9) and insight (level 7). Practitioners develop increased regulation o thoughts, feelings and behaviors (level 6). They report increased attention to their physiological processes as well as increased awareness of connections between their physiology and their environment (level 5). Practitioners are encouraged to find the best combination of strategies to improve their overall health and well being. They become more sensitive to changes in their internal and external environments, and they develop skills to adjust and respond more quickly to these changes (level 4). By repeating these practices over and over, conditioned self- regulation pathways are established (level 3,2), as well as cybernetic self-regulation and homeostatic control (level 1).

Applications to the Treatment of Hypertension

From a systems perspective, qigong involves multiple mechanisms operating a multiple levels. Hence, it follows that qigong practice should be effective in the treatment of disease that involve multiple mechanisms at multiple levels. Hypertension is a chronic disease which is believed to involve multiple levels, multiple factors, and multiple organ system pathological changes. Schwartz (1984) has provided systems diagrams to illustrate how blood pressure is influenced and regulated (see figures 2 and 3).

Drug treatments typically focus on only one or two mechanisms and often have side effects that may be serious. In China, different qigong methods have been evaluated to treat hypertensive patients (Hao, 1991; Hu, 1984; Kuang, 1986; Li, 1987; Wang C., 1985; Wang J.,1987; Wang X., 1990 & 1992; Zu, 1991). One of them is called 'Qigong Medical Exercise'. (Hu, 1984). Hu reported that 53.3% of qigong subjects (total n=31) had decrease of 20 mmHg or more compared to 0% of the control subjects (total n=31). 33.3% of qigong subjects had decreases of 10mmHg compared to 11.1% of control subjects. Data from other clinical studies indicates that large therapeutic effects can been obtained as well. Moreover, not only was blood pressure often reduced to normal levels, but the functioning of almost every organ system, including the brain, the heart and blood vessels, respiration, the kidneys, specific hormones, sequelae were also effectively controlled. Moreover, it was reported that the patients looked more beautiful, younger, more healthy, and experienced a longer life.

This wide range of clinical changes takes on added meaning when viewed from a systems perspective. Systems theory is useful in helping us understand qigong because systems theory is integrative and synthetic - it provides us with a highly organized structure for crossing levels and integrating disciplines. Systems theory helps us more clearly see how complex interactive processes can occur at multiple levels. Qigong practice may achieve such a wide range of effects precisely because it involves the integration of so many processes at so many levels. From a systems perspective, qigong can be used not only to facilitate physiological change, but to help preserve bio-psycho-social balance as well. From a Chinese perspective, with qigong human beings may become 'zhu ren' or'masters of themselves.'