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Qi Gong: Ancient Exercises For Modern Times

Qi Gong and Nei Gong are terms used today to describe a category of exercises originally referred to as yang sheng, “life nourishing” exercises. Although records of Qi Gong exercises date back to the Han Dynasty (206 BC to AD 220), they may be more important for the health and fitness concerns of today than they were then. With science and technology focused more than ever on health and fitness what could ancient Qi Gong exercises possibly have to offer citizens of the 21st century? To answer this question, we need to try to define fitness and health, and ask some other basic questions.

One difficulty in approaching health and exercise regimes is figuring out what to do and how much to do it. What is appropriate and what is the ultimate goal? If the ultimate goal is  to improve one’s health or to raise one’s level of fitness then we need to understand what health and fitness really mean, both in general and for each of us as an individual.

Fitness & Health

Fitness is defined variously as:

  1. The condition of being suitable or appropriate.
  2. Being in good condition or good health.
  3. The capability of the body of distributing inhaled oxygen to muscle tissue during increased physical effort.

What constitutes suitable and appropriate when we are talking about exercise? Most people want to be healthy and to be active. For one person, this means being able to walk and sit without pain or to be able to enjoy playing with children or grandchildren. For another, this might mean climbing a mountain or skiing in a race. Therefore, what is appropriate for one person might be very different for another.

“Being in good condition or good health.” What is health? Health is generally defined as: “A condition of body and mind with reference to soundness and vigor.” We all can identify someone who has these qualities when we see them, but describing what someone in good health looks like is difficult. Quantifying what makes that person “sound and vigorous” is even harder, hence the endless articles and studies that are confusing and often contradictory.

The third definition really talks about aerobic fitness. Aerobic fitness has become the standard measure of fitness/health in the last 30 years. It is measurable, and quantifiable (although no one is quite sure what the numbers should be). Yet aerobic fitness  is only one kind of fitness, one kind of health. Other measures of fitness are also popular: how much weight one can lift, how many pushups and situps they can perform or how far they can stretch.  Soundness and vigor have something to do with these abilities, but somehow the numbers often fail to produce the desired result. Yet criteria like these are the prevalent benchmarks of an individual’s fitness. Why?

In the West we pride ourselves on reason and science, and we like to think we base our decisions on judicious employment of these tools. Science likes to rely on numbers, as numbers appear to provide an unbiased account of reality. It is no surprise that exercises that can be quantified tend to be the ones that are researched and marketed by the mass media.

Ultimately this has led to the creation a vast industry that markets new products and exercise regimens every year. Once the fitness craze became big business, exercise fads took over. Just like the jeans you bought last year that you can’t find this year because a new product is for sale, the fitness industry is wired to produce a new product or market a new class as often as possible. If a scientific study appears to back up the new product, so much the better.

So we have spinning classes, aerobics, jogging, plyometric training, weight training, exercise bikes and elliptical machines and treadmills, Pilates, Gyrotonics, dozens of different yoga methods, stretching classes core strength workouts and balance training. The list goes on and on. How does one choose from these fads and decide what is the correct program for their individual needs?

Appropriate Exercise

What is appropriate exercise? An exercise routine used by a professional sports team or designed for 18 year old US Marine recruits may not be appropriate for the average person who simply wants to improve and maintain heath and vitality. The short term goals of athletes often have little relationship to the daily fitness needs of a business executive, a working mother or a small business owner. Nowhere is this question of appropriateness more important than when one is recovering from an injury or suffering from chronic pain.

As a practitioner of Chinese Medicine, at least 60% of my patients are in pain. Almost every day I see someone who has injured themselves trying to improve their health through exercise. All too often, exercise exacerbates existing body misalignment, dysfunctional movement patterns, and muscle imbalances. In many popular exercise routines muscles and joints are engaged incorrectly – reinforcing, rather than correcting, these imbalances.  Add to this weight, resistance or an obsession with time, distance and repetitions, and the possibility of injury is very real.

Often physical therapy falls into the same trap by focusing primarily on building or stretching the body’s large muscle groups: the pecs, deltoids, traps, biceps, triceps, quads, hamstrings calves, the large superficial back muscles and the abs. This prejudice towards strength and flexibility that are measurable does not address the real issue, which is the correct sequential stimulation and relaxation of muscles in relationship to each other and to the body as a whole. By not focusing on the bigger picture, injuries can easily be exacerbated. A classic example is a woman in her sixties who injured her shoulder exercising. The prescribed physical therapy: weights and other resistance exercises to strengthen the shoulder muscles created more pain: “I am stronger, my muscles are bigger and I can lift more weight, but my shoulder hurts more than ever and I still can’t raise my arm all the way.” The therapy did not help because she was using her arm incorrectly and the joint itself was misaligned, a situation that was easily corrected by a simple acupuncture treatment and showing her some basic Qi Gong exercises that corrected movement patterns that had been disrupted by the injury.

Movement & Health

Movement is one of the key ingredients to maintaining health. To watch an animal move is to see life itself in action, the subtle interplay of strength, flexibility and agility. Movement is inherent to life. Our breath moves in and out constantly. The heart beats, making the blood course through our veins. Digestion is a continual cycle of nutrients and liquids moving through us several times a day. Our internal functioning is composed of endless movements that take place without our conscious awareness. Exercise can modulate these movements, improve their efficiency, make them less prone to disruption. One of the biggest obstacles to our health in the modern world is the lack of movement inherent in a sedentary lifestyle. Our natural animal-like movement has been stifled by inactivity. The less we move, the less we can move.

When injured or in pain there is a tendency to restrict one’s movements, to stay away from the pain. Sometimes this is a good thing, as in a fresh injury where the body instinctively protects itself while assessing the severity of the damage. However when this tendency becomes habitual, it can do great harm. A classic example is back pain. When your back goes out, it can be excruciating, bending, walking, even breathing deeply can be painful. The impulse is to lie down, to take a painkiller, not to move the painful area or even breathe into the area. This can prolong the pain, spinning what could be a brief episode out into weeks of pain. It also sets the body up for re-injury. A number of studies have shown that exercise actually eases back pain, and that patients who exercised took far less pain medication to manage their pain.

The Chinese refer to frozen shoulder as “fifty year old shoulder.” The reason this condition is more prevalent in older people is largely because they move less. It is not uncommon for people over 50 to be less active. Often their daily life does involve reaching up high, and many tasks can be performed with small motions in front of the body. If it is hard to reach the can of peas on a high shelf, it is put lower within easy reach.  Over time the shoulder stops being able to lift all the way. It does not need to move, so the movement itself is lost.  Alternatively, an injury such as a rotator cuff tear makes certain movements painful, reaching up or reaching back to unhook a bra, or put on a belt. You avoid the movements because they hurt, later you can’t do them even when the pain is not as acute. The cure is movement. Moving everyday and correcting dysfunctional movement patterns is the key to vibrant health.

The Movements We Need the Least Often Attracts Us the Most

This seems contradictory. Don’t our bodies have an innate wisdom? One would think so, but as human beings we have a natural tendency to gravitate toward movements and exercises that are natural and easy, that give us an immediate sense of accomplishment.  We tend to shy away from our weak points or from things that don’t come easily. A good example is weight training. Men who are already muscular are often attracted to weight training. They can easily make rapid progress, put on muscle fast and increase the amount of weight they lift in a short time. It is easy for them. On the other hand yoga classes are full of lithe, hyper-flexible women who can more easily perform some of the postures that require great flexibility. Of course men also want to look muscular, as culturally that is part of being masculine, just as for women flexibility and elegant postures are culturally more feminine.

Choosing exercise regimens based on what comes easily, rather than working on our weak points often sets us up for injury, or prevents us from recovering from one. The weight lifter who is already bound up and inflexible would do better to focus on flexibility and agility, while the loose-jointed yoga adept is prone to joint instability through overstretching ligaments and tendons.

The Problems with Popular Exercise Methods

There are several reasons why many of today’s exercise fads are inappropriate for the average person and are not well suited for recovery from injury or chronic pain:

How Long? How Far? How Much?

Measuring is a way to see progress to create standards and to see were we stand relative to others. While this is useful in many instances, the natural human tendency to focus on external standards for determining fitness often does more harm than good. If you can run 4 miles, running 6 might not necessarily be better. Most of the runners who come to see us for foot, knee, hip and back problems tell a similar tale. “I was running 5 miles a day and felt great. I increased to seven and then my ______ started hurting. Now I am hardly exercising at all and it still hurts.” This is a common tale among runners, its corollary being “I injured my shoulder when I increased the amount of weight I was  bench pressing at the gym.” This syndrome is not confined to runners and weight lifters. Yoga practitioners who force themselves into the lotus position and end up with knee pain are also trying to adhere to a fixed standard. The ingrained competitive streak, that we all seem to have, is an accident waiting to happen when your exercise routine focuses unduly on external standards.

One Muscle at a Time

Focusing on the strength of isolated, large muscle groups at the expense of flexibility and whole body movement (as in weightlifting) or trying to stretch individual muscles, rather than creating agility and flexibility in the whole body is often counter productive. The body uses muscles, joints, tendons ligaments and bones in sequential overlapping patterns. The appropriate muscles and joints are activated at the appropriate time to perform both complex and simple movements. This is one of the components of natural movement. Isolation of body parts to increase strength and flexibility, particularly by locking them into machines, is unnatural. It takes away the protective buffers which are built into normal movement.

Working Up A Sweat-Pushing Too Hard

Getting a sweat, feeling our heart beating and blood pumping lets us know we are alive. However we don’t always need to push the body to its limits to feel alive, in fact regularly pushing the limits can exhaust the body’s reserves over time, making it more susceptible to injury. Working out hard when it is too hot too often, keeping up in your spinning class even though it exhausts you, or being a “weekend warrior” who goes all out in a soccer game two days a week is not a recipe for health and fitness.  

Expert Supervision Required

Some exercises do use the body correctly, do not push people too far and do not rely too much on external standards, yet they still fall short of being a viable method suitable for the average person to maintain fitness and health. Pilates, Gyrotonics, Feldenkrais work are all very effective methods of rehabilitation (what they were originally created for) and are regularly used to help people in chronic pain. The drawback of these methods is that it is very difficult for most people to do the exercises correctly on their own. A trainer is usually required to oversee each exercise session, meaning that most people will not be able to continue these kinds of programs throughout their life.

Repetitive Movement

Repetitive movement is not in itself bad. Thousands of repetitions are necessary to master even a single movement, let alone complex chains of movements. However repeating movements that are imbalanced, or are not performed with correct alignment and mind-intention can damage the body, and often fail to deliver the promised results. The repetitive movements common to activities like jogging, biking, and swimming can be problematic particularly if the there are muscle imbalances, or if the movements themselves are not performed properly. It is all too common to see joggers who hold their upper body completely still. This eliminates the natural diagonal spirals inherent in running and reduces the exercise to an two-dimensional up and down pumping action, which pounds the spine into the ground. In addition over the many thousands of repetitions a dysfunctional movement pattern is slowly programmed into the body’s neuromuscular memory.       


Why do people switch exercise routines frequently, go to different gyms with the latest machines, buy new exercise equipment every year? Partially it is because many exercise routines are boring and one-dimensional. They do not work the body as a whole, they do not offer levels of engagement beyond faster, harder and more. The routine or the practice does not feed the soul. It may sound harsh but a window full of people running on treadmills  and watching television looks a lot like hamsters in a cage running on a wheel.

What is Qi Gong and Why is it Different?

Some of the oldest medical records recovered from Han Dynasty (206 BC- AD 220 ) tombs contain detailed descriptions of exercises that were used to treat specific ailments. Some of these exercises were based on the movements of animals and were used to prevent disease and preserve health. Others were used to treat specific diseases and to expel pathogens from the body. Over centuries these exercises were refined and expanded to include movements and exercise routines that prevent illness, strengthen the functioning of  the internal organs, relieve pain and restore normal functioning of the bones, joints, tendons, ligaments and muscles.

How do these exercises work and what makes them different and more effective than other forms of exercise?

1) Qi Gong exercises are based on natural movements that move the joints, soft tissue and bones in accordance with their natural design.

When performing qi gong exercises, nothing goes against the body’s innate structure and the integrity of the structure is maintained at all times. For example, the ligaments of the hip joint have twisted figure-8 structure which creates spiraling forces. Proper hip movement needs to follow the natural spirals built in to the structure of the hip. Improper movements can cause these ligaments to kink and bind restricting normal movement.

2) In Qi Gong exercises the whole body is considered, each part in relation to all the other parts.

The body is meant to be used as a whole. Rather than focusing strengthening or stretching individual muscles, qi gong exercises train the muscles and joints of the whole body to act synergistically, contracting and relaxing at the appropriate moment. Even when a movement appears to be isolated, attention is focused on the subtle movements happening in the rest of the body.  Integrated movement automatically produces strength and flexibility, whereas stretching and strengthening individual muscle groups rarely produces integrated movement

3) Qi Gong exercises teach the body to move efficiently by balancing tension and relaxation.

The Chinese word song, which is often translated as “relax”, really means to slacken.  For one muscle to contract efficiently other muscles must slacken and it is this interplay of tensing and slackening throughout the whole body that produces coordinated, efficient movement.

4) Qi Gong exercises work with the joints in their correct alignment.    

Lining up the joints takes advantage of the body’s natural strength. In this way structures are not compromised, because their actions are not isolated, but are instead buffered by the actions of other joints.  This helps to prevent injury. It is much like the famous metaphor for strength in numbers: one thin stick by itself is easily snapped, but tie several thin sticks together and they can resist tremendous forces. A good  example of this is carpal tunnel syndrome, which is attributed to repetitive movements like typing on a computer keyboard or using a mouse. Moving just one finger while keeping the rest of the body still, stresses the tendons of that finger and the wrist which leads to irritation and swelling.  Used alone, in isolation the wrist and finger are weak, but when the whole arm and shoulder subtly move with the fingers no one joint takes the strain.

5) Qi Gong exercises reeducate the body, restoring its natural movement patterns through a kind of neuro-muscular re-programming.

When part of the body is injured it often becomes separated from the rest of the body. That is, it ceases to function in coordination with the body as a whole. Resistance training, flexibility exercises and aerobics will not reconnect the injured area to the rest of the body. However, simple movements performed correctly, movements that are natural, balanced, aligned and integrated are very effective at restoring the body’s innate integrity. This is integrated movement.

Integrated Movement

Whether it is a cat jumping onto a table or Michael Jordan taking to the air, we all know integrated movement when we see it. There are five components to integrated movement:

1) Integrated movement is whole body movement.

Even when it may seem as though just one part of the body is moving, in fact the whole body is subtly moving with it.

2) Integrated movement is connected and harmonious.

When the leg moves the arm moves in synchrony. The upper body and lower body move in harmony with the joints “lined up”. In this way movement is efficient with no wasted energy.

3) Integrated movement moves in spirals rather than in lines or planes.

Muscle fibers, ligaments and even bones are aligned in tubes, spirals and fan shapes that literally wind and unwind as the body moves. Simple two dimensional movements like bicep curls and many other weight or machine bound exercises do not take advantage of the body’s natural structure. By Isolating movements to one muscle on a two-dimensional plane many exercises bypass the natural buffers inherent in spiral movements, thereby setting the body up for injury.

4) Integrated movement coordinates respiration with movement.

Our tissues operate best when the breath can move through them and when we breathe smoothly throughout a movement. Uneven breathing, shallow breathing and other unnatural patterns of respiration can seriously effect the bodies health and interfere with efficient movement.

5)  Integrated movement is mindful movement.

For exercises to achieve their full potential, the mind must be engaged in the movements. We can watch television while riding an exercise bike but then we are not paying attention to posture, breathing, or the subtle interplay of the muscles as our legs work. This relaxed observation is an important element in doing exercise correctly and thereby reaping its full benefit.

Qi Gong & Health

Regular daily practice of qi gong is said to promote health and nourish life. This is not a grandiose claim. There are a number of reasons why qi gong exercises have a powerful effect on health and resistance to disease.

1) Qi Gong exercises are completely congruent with Chinese medicine.

Chinese medicine has been shown to be clinically effective at improving health and preventing disease. When regularly practiced, qi gong exercises can function like Chinese medical treatments, actually improving or restoring the function of the internal organs as well as the muscles and joints. Even the simplest qi gong exercises, can produce remarkable changes in posture, mental attitude, increased lung capacity and  improved vitality. Additionally, many qi gong exercises target specific imbalances and health issues that can lead to chronic illness, pain and dysfunction.

  •  One study showed that qi gong exercise has been shown to increase blood flow to the brain, creating  improvements in symptoms such as memory, dizziness, and insomnia
  • A study of people with high blood pressure showed that after 12 weeks of qi gong, blood pressure and cholesterol levels were lower.
  • A study in Korea indicated similar effects on blood pressure, as well as reduced cortisol levels. Cortisol is produced by the adrenal gland and is often referred to as the “stress hormone” as it is involved in response to stress.
  • Unfavorable changes of sex hormone levels due to aging were retarded by regular practice of qi gong exercises.
  • Superoxide dismutase (SOD), an anti-aging enzyme that is produced naturally by the body, declines with age. SOD is believed to destroy free radicals that may cause aging. In one study the SOD levels of retired workers who did qi  gong exercises showed that the mean level of SOD was increased by qigong exercise.
  • A study sponsored by the National Institute on Aging and National Center for Complementary and Alternative Medicine compared the effects of Qi Gong and Tai Chi, on adults 60 and older, measuring their immunity to the Varicella Zoster Virus that causes shingles. After 12 weeks, the participants had raised their immunity to the virus.
  • Regular practice of qi gong can improve sleep and reduce daytime fatigue and drowsiness.
  • Qi gong and Tai Chi have been shown to reduce stress and psychological distress.
  • The practice of qi gong has been shown to reduce arthritis pain and stiffness in the joints. Regular practice of qi gong helped patients reduce their pain medication.

2) Qi Gong exercises incorporate and emphasize natural breathing. 

Breathing “is” life. While we can go without food and water for days, we cannot go without breathing for even a few minutes. This most basic life rhythm has profound effects on the whole human organism. The movements of the diaphragm and ribs in inhalation and exhalation help the vena cava to return blood to the heart. Additionally, as the organs of digestion have direct and indirect attachments to the diaphragm, its piston-like action in breathing aids digestion and peristalsis. Even the kidneys move slightly with every breath. It is no surprise that impaired breathing can have profound affects on the functioning of the internal organs.

  •  It has been clinically shown that slow, even breathing at a rate of less than ten breaths per minute can modulate blood pressure. Regular practice of slowed breathing actually produced a drop in BP of 20-30 points. The FDA has approved biofeedback-like devices that help slow breathing in order to treat hypertension.
  • Hypertensive patients practicing qi gong along with drug therapy were shown to have a lower incidence of  stroke and were able to reduce drug intake.
  • Asthma patients who practiced qi gong regularly, reduced their medication, and took less sick leave due to lung problems

3)  Qi Gong exercise help to clear blockages in circulation.  

  • Improvements in micro-circulation were noted in patients who practiced qigong regularly.
  • Several research studies have indicated that qi gong produces beneficial effects on cardiovascular function such as increased cardiac output, oxygen uptake and adaptation to higher altitudes.

4)  The whole body is exercised.

Even in the simplest qi gong movements the whole body is exercised, so that an integration is achieved between the upper and lower body. This increases functional strength.

  • Tai Chi and Qi Gong exercises improve balance and flexibility preventing falls in the elderly.
  • Qi Gong exercises have been used by martial art practitioners for centuries to build strength and vitality.

5)  Revitalize the body without overstraining the body.

Many exercises overstrain the body leading to injury. Additionally, for those with reduced energy due to overwork or aging, it has been shown that moderate exercise for 30 minutes a day, can produce enormous benefits in  mood, general health, body weight and vitality.  Qi gong exercises revitalize the body without fatiguing it, because the exercises themselves do not tire the body or tear down muscles in order to build them up. Simply put, what you get back from the exercises is greater then the effort put in to perform them.  

6) Can be done by everyone and offers something for everyone.

The problem with many exercise routines is that they are not difficult or challenging for some, and are far too difficult for others. Qi gong exercises are adaptable to the individual so that even an athlete can be challenged, while a frail individual is not exhausted .

7) Qi Gong can be done anywhere and requires no equipment.

There is no need to purchase expensive gym memberships or the latest fitness gizmo. Qi gong exercise can be done anywhere, often in a small space. Some qi gong exercises can be done lying down or sitting. I often practiced Meridian Qi Gong sitting on a bus commuting in to work.

8) Qi Gong is not boring.

Any repetitive exercise can become boring over time. Qi gong exercises are less boring than many exercise routines because the mind is fully engaged in the movement. Additionally, there are many types of qi gong and different methods exercise the body differently. Some routines work on the musculo-skeletal system emphasizing posture and alignment. Some focus on breathing only, while others use sound or rhythmic movement to create vibrations inside the body that break up unhealthy blockages. Some develop strength by working inward from the musculature , others emphasize gentle hidden movements or guided imagery that affect the whole body from the inside out.

The same exercises can also be performed in different ways, fast or slow, lightly and gently or with greater force and strength. Postures can also be altered, for example lowering the stance to develop leg strength, twisting farther to increase flexibility. Some examples of different sets are listed below:

  • Taoist Meditation (breathing)
  • Taoist Light and Color Meditation (imagery and breathing)
  • Patting/Self Massage (Anmo) Qi Gong
  • Six Healing Sounds Qi Gong (Liu Zi Jue): uses sound vibrations produced by the diaphragm throat and mouth to break blockages and tone the organs.
  • Yi Jin Jing (Tendon-Muscle Strengthening Exercises): invigorate the body and develop strength.
  • Ba Duan Jin (Eight Pieces of Brocade) & Wu Xing Qi Gong (5 Element Qi Gong) both develop strength while squeezing and activating the internal organs.
  • Xing Yi Nei Gong develops strength and a loose but connected and strong body.
  • Five Animal Play (Wu Qin Xi), uses stepping and body movements that mimic animal movements to create internal vibrations that strengthen the organs and the whole body.
  • Swimming Dragon Qi Gong powerfully mobilizes the entire spine, improving its flexibility and range of motion while toning the digestive system and improving circulation.
  • Stake Standing postures strengthen and consolidate the body’s energy.
  • Seasonal Qi Gong helps one to harmonize with the seasonal changes and helps to prevent seasonal illness and allergies.
  • Tu Na (breathing) Exercises combine breathing with movement to help the lung function while loosening up the spine and ribcage.
  • Marrow Washing  Nei Gong frees the joints and releases soft tissue restrictions while consolidating he marrow in the bones.
  • Tian Kan (Heavenly Stem) Exercises use spiraling, torsional forces to wring out the spine while integrating the  movements of the waist, the spinal column and the limbs.
  • Meridian Qi Gong focuses on directing breath and energy through the channels and collaterals (meridians) the pathways to improve organ functioning.
  • The more quiescent Dao Yin or Health Preservation Exercises refresh and revitalize the body while preventing illness.
  • Ba Gua Ding Shi Nei Gong is a dynamic way of strengthening the body while improving balance and mobility.