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Qigong, chi kung, or chi gung (simplified Chinese: 气功; traditional Chinese: 氣功; pinyin: qìgōng; Wade–Giles: chi gong; literally "Life Energy Cultivation") is a practice of aligning movement, breath, and awareness for exercise, healing, and meditation. With roots in Chinese medicine, philosophy, and martial arts, qigong is traditionally viewed as a practice to cultivate and balance qi (chi) or what has been translated as "life energy".
Qigong practices typically involve coordinating slow flowing movement (or stillness) of the body, deep rhythmic breathing, and mental focus on philosophical concepts such as visualization of guiding qi through the body. As a kind of meditation, qigong is practiced with a calm mind and relaxed body. Qigong is now practiced throughout China and worldwide, and is considered by some to be exercise, and by others to be a type of complementary medicine or meditative practice. According to Daoist, Buddhist, and Confucian philosophy, respectively, qigong allows access to higher realms of awareness, awakens one's "true nature", and helps develop human potential.
Research concerning qigong has been conducted for a wide range of medical conditions, including hypertension, pain, and cancer treatment. Most systematic reviews of clinical trials have not been conclusive, and all have been based on poor quality clinical studies, such that no firm conclusions about the health effects of qigong can be drawn at this stage.
Qi (or chi) is often translated as life energy, referring to energy circulating through the body; though a more general definition is universal energy, including heat, light, and electromagnetic energy; and definitions often involve breath, air, gas, or relationship between matter, energy, and spirit. Qi is the central underlying principle in traditional Chinese medicine and martial arts. Gong (or kung) is often translated as cultivation or work, and definitions include practice, skill, mastery, merit, achievement, service, result, or accomplishment, and is often used to mean gongfu (kung fu) in the traditional sense of achievement through great effort. The two words are combined to describe systems to cultivate and balance life energy, especially for health.
Although the term qigong (氣功) has been traced back to Daoist literature of the early Tang Dynasty (618-907 AD), the term qigong as currently used was promoted in the late 1940s through the 1950s to refer to a broad range of Chinese self-cultivation exercises, and to emphasize health and scientific approaches, while de-emphasizing spiritual practices, mysticism, and elite lineages.
With roots in ancient Chinese culture dating back more than 4,000 years, a wide variety of qigong forms have developed within different segments of Chinese society: in traditional Chinese medicine for preventive and curative functions, in Confucianism to promote longevity and improve moral character, in Taoism and Buddhism as part of meditative practice, and in Chinese martial arts to enhance fighting abilities. Contemporary qigong blends diverse and sometimes disparate traditions, in particular the Daoist meditative practice of "internal alchemy" (Neidan 內丹术), the ancient meditative practices of "circulating qi" (Xing qi 行氣) and "standing meditation" (Zhan zhuang 站桩), and the slow gymnastic breathing exercise of "guiding and pulling" (Dao yin 導引). Traditionally, knowledge about qigong was passed from adept master to student in elite unbroken lineages, typically with secretive and esoteric traditions of training and oral transmission.
Starting in the late 1940s and the 1950s, the mainland Chinese government tried to integrate disparate qigong approaches into one coherent system, with the intention of establishing a firm scientific basis for qigong practice. In 1949, Liu Guizhen established the name "Qigong" to refer to the system of life preserving practices that he and his associates developed based on Dao yin and other philosophical traditions. This attempt is considered by some sinologists as the start of the modern or scientific interpretation of qigong. During the Great Leap Forward (1958–1963) and the Cultural Revolution (1966–1976), qigong, along with other traditional Chinese medicine, was encouraged in state-run rehabilitation centers and spread to universities and hospitals, but was under tight control with limited access among the general public. After the Cultural Revolution, qigong, along with t'ai chi, was popularized as daily morning exercise practiced en masse throughout China.
Popularity of qigong grew rapidly during the Deng and Jiang eras of the 1970s through 1990s, with estimates of between 60 and 200 million practitioners throughout China. Along with popularity and state sanction came controversy and problems: claims of extraordinary abilities bordering on the supernatural, pseudoscience explanations to build credibility, a mental condition labeled qigong deviation, formation of cults, and exaggeration of claims by masters for personal benefit. In 1985, the state-run "National Qigong Science and Research Organization" was established to regulate the nation's qigong denominations. In 1999, in response to widespread revival of old traditions of spirituality, morality, and mysticism, and perceived challenges to State control, the Chinese government took measures to enforce control of public qigong practice, including shutting down qigong clinics and hospitals, and banning groups such as Zhong Gong and Falun Gong.:161–174
Through the forces of migration of the Chinese diaspora, tourism in China, and globalization, the practice of qigong spread from the Chinese community to the world. Today, millions of people around the world practice qigong and believe in the benefits of qigong to varying degrees. Similar to its historical origin, those interested in qigong come from diverse backgrounds and practice it for different reasons, including for exercise, recreation, preventive medicine, self-healing, self-cultivation, meditation, and martial arts training.
Qigong comprises a diverse set of practices that coordinate body (調身), breathing (調息), and mind (調心) based on Chinese philosophy. Practices include moving and still meditation, massage, chanting, sound meditation, and non-contact treatments, performed in a broad array of body postures. Qigong is commonly classified into two foundational categories: 1) dynamic or active qigong (dong gong), with slow flowing movement; and 2) meditative or passive qigong (jing gong), with still positions and inner movement of the breath.:21770-21772 From a therapeutic perspective, qigong can be classified into two systems: 1) internal qigong, which focuses on self-care and self-cultivation, and 2) external qigong, which involves treatment by a therapist who directs or transmits qi.:21777-21781. As moving meditation, qigong practice typically coordinates slow stylized movement, deep diaphragmatic breathing, and calm mental focus, with visualization of guiding qi through the body. While implementation details vary, generally qigong forms can be characterized as a mix of four types of practice: dynamic, static, meditative, and activities requiring external aids.
There are numerous qigong forms. 75 ancient forms that can be found in ancient literature and also 56 common or contemporary form have been described in a qigong compendium.:203–433 The list is by no means exhaustive. Many contemporary forms were developed by people who had recovered from their illness after qigong practice.
In 2003, the Chinese Health Qigong Association officially recognized four health qigong forms:
In 2010, the Chinese Health Qigong Association officially recognized five additional health qigong forms:
Other commonly practiced qigong styles and forms include the following:
The most advanced practice is generally considered to be with little or no motion.
Over time, five distinct traditions or schools of qigong developed in China, each with its own theories and characteristics: Chinese Medical Qigong, Daoist Qigong, Buddhist Qigong, Confucian Qigong, and Martial Arts Qigong.:30–80 All of these qigong traditions include practices intended to cultivate and balance qi.
The theories of ancient Chinese Medical Qigong include the Yin-Yang and Five Phases Theory, Essence-Qi-Spirit Theory, Zang-Xiang Theory, and Meridians and Qi-Blood Theory, which have been synthesized as part of Traditional Chinese Medicine (TCM).:45–57 TCM focuses on tracing and correcting underlying disharmony, in terms of deficiency and excess, using the complementary and opposing forces of yin and yang (陰陽), to create a balanced flow of qi. Qi is believed to be cultivated and stored in three main dantian energy centers and to travel through the body along twelve main meridians (Jīng Luò 經絡), with numerous smaller branches and tributaries. The main meridians correspond to twelve main organs (Zàng fǔ 臟腑)). Qi is balanced in terms of yin and yang in the context of the traditional system of Five Phases (Wu xing 五行). A person is believed to become ill or die when qi becomes diminished or unbalanced. Health is believed to be returned by rebuilding qi, eliminating qi blockages, and correcting qi imbalances. These TCM concepts do not translate readily to modern science and medicine.
Qigong has been recognized as a "standard medical technique" in China since 1989, and is sometimes included in the medical curriculum of major universities in China.:34 The 2013 English translation of the official Chinese Medical Qigong textbook used in China:iv,385 defines CMQ as "the skill of body-mind exercise that integrates body, breath, and mind adjustments into one" and emphasizes that qigong is based on "adjustment" (tiao 調, also translated as “regulation”, “tuning”, or “alignment.”) of body, breath, and mind.:16–18 As such, qigong is viewed by practitioners as being more than common physical exercise, because qigong combines postural, breathing, and mental training in one to produce a particular psychophysiological state of being.:15 While CMQ is still based on traditional and classical theory, modern practitioners also emphasize the importance of a strong scientific basis.:81–89 According to the 2013 CMQ textbook, physiological effects of qigong are numerous, and include improvement of respiratory and cardiovascular function, as well as possible beneficial effects on neurophysiology.:89–102
Conventional or mainstream medicine includes specific practices and techniques based on the best available evidence demonstrating effectiveness and safety. Qigong is not generally considered to be part of mainstream medicine because clinical research concerning effectiveness of qigong for specific medical conditions is inconclusive at this stage, and because at present there is no medical consensus concerning effectiveness of qigong. Qigong is generally considered to be a complementary treatment, included as a part of an integrative medicine approach.
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Integrative medicine (IM) refers to "the blending of conventional and complementary medicines and therapies with the aim of using the most appropriate of either or both modalities to care for the patient as a whole",:455–456 whereas complementary generally refers to "using a non-mainstream approach together with conventional medicine", and alternative refers to "using a non-mainstream approach in place of conventional medicine". Qigong is used by integrative medicine practitioners to complement conventional medical treatment, based on complementary and alternative medicine (CAM) interpretations of the effectiveness and safety of qigong.:22278–22306
Scientists interested in qigong have sought to describe or verify the effects of qigong, to explore mechanisms of effects, to form scientific theory with respect to Qigong, and to identify appropriate research methodology for further study.:81–89
In terms of traditional theory, the existence of qi has not been independently verified in an experimental setting.
The White House Commission on Complementary and Alternative Medicine (CAM) Policy recognized challenges and complexities to rigorous research concerning effectiveness and safety of CAM modalities such as qigong; emphasized that research must adhere to the same standards as conventional research, including statistically significant sample sizes, adequate controls, definition of response specificity, and reproducibility of results; and recommended substantial increases in funding to address the lack of adequate funding for rigorous research. Most existing clinical trials have small sample sizes and many have inadequate controls. Of particular concern is the impracticality of double blinding using appropriate sham treatments, and the difficulty of placebo control, such that benefits often cannot be distinguished from the placebo effect.:22:22278–22306 Also of concern is the choice of which qigong form to use and how to standardize the treatment or dose with respect to the skill of the practitioner leading or administering treatment, the tradition of individualization of treatments, and the treatment length, intensity, and frequency.:130-133:6869–6920,22361-22370
People practice qigong for many different reasons, including for exercise and recreation, preventive medicine and self-healing, meditation and self-cultivation, and training for martial arts. In recent years a large number of books and videos have been published that focus primarily on qigong as exercise and associated health benefits. Practitioners range from athletes to the physically challenged. Because it is low impact and can be done lying, sitting, or standing, qigong is accessible for disabled persons, seniors, and people recovering from injuries.
Therapeutic use of qigong is directed by TCM, CAM, integrative medicine, and other health practitioners. In China, where it is considered a "standard medical technique",:34 qigong is commonly prescribed to treat a wide variety of conditions, and clinical applications include hypertension, coronary artery disease, peptic ulcers, chronic liver diseases, diabetes mellitus, obesity, menopause syndrome, chronic fatigue syndrome, insomnia, tumors and cancer, lower back and leg pain, cervical spondylosis, and myopia.:261–391 Outside China qigong is used in integrative medicine to complement or supplement accepted medical treatments, including for relaxation, fitness, rehabilitation, and treatment of specific conditions.
Qigong is generally viewed as safe. No adverse effects have been observed in clinical trials, such that qigong is considered safe for use across diverse populations. Cost for self-care is minimal, and cost efficiencies are high for group delivered care. Typically the cautions associated with qigong are the same as those associated with any physical activity, including risk of muscle strains or sprains, advisability of stretching to prevent injury, general safety for use alongside conventional medical treatments, and consulting with a physician when combining with conventional treatment. Qigong is promoted as safe for use "as a viable, accessible alternative, especially for individuals who might prefer these activities over more conventional or vigorous forms of exercise".
Qigong is practiced for meditation and self-cultivation as part of various philosophical and spiritual traditions. As meditation, qigong is a means to still the mind and enter a state of consciousness that brings serenity, clarity, and bliss. Many practitioners find qigong, with its gentle focused movement, to be more accessible than seated meditation.
Qigong for self-cultivation can be classified in terms of traditional Chinese philosophy: Daoist, Buddhist, and Confucian.
The practice of qigong is an important component in both internal and external style Chinese martial arts. Focus on qi is considered to be a source of power as well as the foundation of the internal style of martial arts (Neijia). T'ai chi ch'uan, Xing yi, and Baguazhang are representative of the types of Chinese martial arts that rely on the concept of qi as the foundation.  Extraordinary feats of martial arts prowess, such as the ability to withstand heavy strikes (Iron Shirt, 鐵衫)  and the ability to break hard objects (Iron Palm, 铁掌)   are abilities attributed to qigong training.
Basic and clinical research in China during the 1980s was mostly descriptive, and few results were reported in peer-reviewed English-language journals.:,22060-22063 A 1996 review of selected Chinese research concluded that there are many potential medical applications of qigong. Qigong became known outside China in the 1990s, and clinical randomized controlled trials (RTCs) investigating the effectiveness of qigong on health and mental conditions began to be published worldwide, along with systematic reviews.:21792-21798
Although clinical research examining health effects of qigong is increasing, there is little financial or medical incentive to support research, and still only a limited number of studies meet accepted medical and scientific standards of randomized controlled trials (RCTs). Clinical research concerning qigong has been conducted for a wide range of medical conditions, including bone density, cardiopulmonary effects, physical function, falls and related risk factors, quality of life, immune function, inflammation, hypertension, pain, and cancer treatment. A 2011 overview of systematic reviews of clinical trials concluded that "the effectiveness of qigong is based mostly on poor quality research" and "therefore, it would be unwise to draw firm conclusions at this stage". Although a 2010 comprehensive literature review found 77 peer-reviewed RCTs; systematic reviews for particular health conditions show that most clinical research is of poor quality, typically because of small sample size and lack of proper control groups, with lack of blinding associated with high risk of bias.
In the 2011 overview of systematic reviews, for the period 2004-2010, ten systematic reviews were identified as meeting criteria of "explicit and repeatable methods section describing the search strategy and explicit inclusion/exclusion criteria"; of these, five reviews concluded that qigong is effective, and five drew equivocal conclusions; the primary studies and three of the reviews were associated with a high risk of bias; and the most frequent limitations of the primary studies were small sample size and lack of proper control group.
Specifically, systematic reviews found equivocal results of internal or external qigong for cancer treatment, and internal qigong for chronic pain, diabetes, and Parkinson's disease. Systematic reviews found positive effects of external qigong for pain,and positive effects of internal qigong for hypertension and chronic conditions. Extensive flaws were noted for one review for diabetes, the review for Parkinson's disease, and one review for chronic conditions in the elderly.
A systematic review of the effect of qigong exercises on hypertension found that the available studies were encouraging for the exercises to lower systolic blood pressure. However, an analysis of the studies that found these results showed that they were of relatively poor quality, with the lack of blinding raising the possibility of bias in the results, so no definitive conclusions could be reached.
A systematic review on the effect of qigong exercises on reducing pain concluded that "the existing trial evidence is not convincing enough to suggest that internal qigong is an effective modality for pain management." Another systematic review which focused on external qigong and its effect on pain, concluded "that evidence for the effectiveness of external qigong is encouraging, though further studies are warranted" due to the small number of studies and participants involved which precluded any firm conclusions about the specific effects of qigong on pain.
A systematic review of the effect of qigong exercises on cancer treatment concluded "the effectiveness of qigong in cancer care is not yet supported by the evidence from rigorous clinical trials." A separate systematic review that looked at the effects of qigong exercises on various physiological or psychological outcomes found that the available studies were poorly designed, with a high of bias in the results. Therefore, the authors concluded, "Due to limited number of RCTs in the field and methodological problems and high risk of bias in the included studies, it is still too early to reach a conclusion about the efficacy and the effectiveness of qigong exercise as a form of health practice adopted by the cancer patients during their curative, palliative, and rehabilitative phases of the cancer journey."
Many claims have been made that qigong can benefit or ameliorate mental health conditions, including improved mood, decreased stress reaction, and decreased anxiety and depression. Most medical studies have only examined psychological factors as secondary goals, however various studies have shown significant benefits such as decrease in cortisol levels, a chemical hormone produced by the body to manage stress.
Over the centuries, a diverse spectrum of qigong forms developed in different segments of Chinese society. Traditionally, qigong training has been esoteric and secretive, with knowledge passed from adept master to student in lineages that maintain their own unique detailed interpretations and methods. Although the practice of qigong was prohibited during the Cultural Revolution of the 1960s, it was once again allowed in 1976 with an emphasis on meditative practice by scholars and gymnastic or dynamic practice by the working masses. Disparate approaches to qigong were merged as part of the cultural change that occurred as China modernized. In contemporary China, the emphasis of qigong practice has shifted away from traditional philosophy, spiritual attainment, and folklore, and increasingly to health benefits, traditional medicine and martial arts applications, and a scientific perspective.
Qigong is now practiced by millions worldwide, primarily for its health benefits, though many practitioners have also adopted traditional philosophical, medical, or martial arts perspectives, and even use the long history of qigong as evidence of its effectiveness.
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