Holistic Health Care Clinic
Restore your HEALTH the most Natural Way
Pain Relief & Body Performance Strategies
Stevenson Xutian*, PhD,
Feng Sun, PhD, MD,
Shusheng Tai, PhD Department of Medicine, University of Alberta, Edmonton, Alberta T6G 2S2 Canada *
Corresponding author: Tel: (780) 492-6703; Fax: (780) 42-4878; E-mail: firstname.lastname@example.org
Tai Chi or Taiji is short of Taijichuan, which is very popular all over the world1. It is a combination of Chinese martial arts with Chinese breath training (Tu Na-a special breath training program for health cultivation), energy flowing guidance (Dao Yin-guiding the Qi-vital bio-energy circulation of the body by mind for health purposes) and meditation progress. Indeed, Taiji is a kind of traditional Chinese Yanshenshu (a mind-body harmonizing technique for health improvement and longevity), an important part of Traditional Chinese Medicine (TCM).
Originally used for the purposes of martial arts, the slow and graceful movements of Taiji, however, also reflect the natural movements of animals and birds, as symbols or ¡°pictures¡±, which were designed to focus on the mind and breathing through a complex series of forms execution. As the forms are practiced in slow but continual and fluidic movements, the breathing is regulated as an integral part of this flowing meditation. The effect of mind regulation produces a sedative state directly on the central nervous system, which in turn helps to stimulate and improve other systems of the body. The calm and graceful movements of Taiji themselves are like physical poetry and meditative dance as well.
When practiced properly, Qi energy is increased, and one often feels a ¡°tingling¡± of fingers and toes, and a warming up of the body. The mind becomes clear and relaxed. The movements help loosen tight muscles, make the joints flexible, increase the posture stability and balance the whole body.
There are various schools or styles of Taiji: Chen, Yang, Wu, Sun and Hao styles2. In 1956, the Simplified Taiji was compiled to address the above problems, which is also known as the Beijing Style. It is comprised of 24 forms (movements), mostly from the traditional Yang Style 108 form. The Simplified Taiji was the result of many Taiji masters working towards standardizing and simplifying Taiji, and focusing on the purpose of promoting health. One of the great importance of the Simplified Taiji is that even though the 24 forms of Taiji is a simplified version, it is still a ¡°traditional¡± sequence with the original martial art applications in every movement. In 1979, the Chinese State Physical Education and Sports Committee again commissioned another changes2. This time the new Taiji version is composed of 48 forms (movements) which inherited the best and strongest points from the Chen, Yang and Wu styles. Currently the Chinese government hopes to popularize it into competitive sport area such as the Olympics.
Taiji was popular from the nineteen century in China as a kind of martial art and slowly transferred to West countries. In the modern world, the main purpose is no longer for fighting but just for health, fitness, diseases prevention and therapy. During the last 30 years, Taiji has spread throughout the world, propagated by immigrant populations and the opening of China from the mid 1970s. Now all of those traditional disciplines of Acupuncture, herbs remedies and Qigong therapies are regaining their respect and public interest as they gradually become supported by modern scientific research evidence.
It is estimated that there are dozen millions people including all ages who are practicing Taiji in China2. It is regulated and organized by the Chinese National Sports Association. There are national ¡°instructor¡± exams and coaching seminars as well as organized competitions within individual family styles. Taiji is also one of the official competition events in the larger national and international martial arts competitions and has been proposed to the international Olympic committee as a competition event of 2008 Olympic.
HISTORY AND PHILOSOPHY
There are some legends about the early history of Taiji. It is difficult to make a completely unified history story about the origin of Taiji, because the secret of Taiji was kept within the individual families for many generations before it was taught to the public. There were missing writing records. It was argued for hundreds years. Most people believed that Taiji was developed to the present style by some martial art masters during the late Ming and early Qing dynasties. The most recently research showed the solid evidence: the earliest ¡°Taiji 13 Forms for Health Cultivation¡± was created in Qianzai Temple in Tang village by Chen Yu-Ting (1600~) from Chen Jiagou village, Wen County, and Li Yan (1606~1643) from Tang village, Beai County, Henan Province of China.3 Wang Zong-Yue£¨1750~£©learned Taiji from Li He-Lin in Tang village and wrote a text entitled ¡°Taijiquan Lun¡±, which is the most important part of a collection of classical writings that form the guidelines for all styles of Taiji.3
The other legend says that the credit for formalizing the soft-style series of exercises into a unified whole belongs to a Taoist Priest, Zhang (or Chang) San-Feng (1270-1364). He lived as a recluse on Mount Wu-Tang in the Hebei Province of China. As the legend goes, Mr. Zhang happened to be walking in the woods when he encountered a crane fighting with a snake. The crane was jabbing at the snake with his long beak in straight angular strikes. The snake was able to avoid the crane by changing his shape and position (staying very soft and resilient), slithering away, and quickly counterattacking while the bird was still committed to its original thrust. Mr. Zhang gleaned from this that it would be possible for a weaker opponent to overcome a stronger one if he becomes soft and elusive. He incorporated this lesson into a new, softer version of a martial art and at the same time a health-promoting program. He reworked the original Forms of Shao Lin with a new emphasis on breathing and inner energy balance. It is reputed that he learnt and created the so called ¡°internal¡± boxing method. He then started a school which was known as the Wu-Tang School of Internal Boxing.
Anyway, the Taiji¡¯s essence principle, no doubt, has its roots in ancient Chinese philosophy, which included inherited Daoism, Buddhism and Confucianism. Some postures of style were inherited from Dao Yin of ¡°Yellow Emperor¡¯s Classis of internal Medicine¡±, 4 the first important book for Traditional Chinese Medicine (about 206 B.C. - 220 A.D.), and ¡°Frolics of the Five Animals" (tiger, deer, bear, monkey and bird) created by ancient famous Chinese doctor Hua Tuo ( about AD 220 - 265).5 Serious students of Taiji understand many of the terms and concepts used in Traditional Chinese Medicine,5 such as ¡°Yin Yang¡±, ¡°Five Elements¡±, Meridians, as well as the circulation of Qi, besides the historic martial arts roots.
The theory is that Zhang San-Feng originated a soft style that combined both existing combat techniques and other movements, primarily designed to increase the flow of Qi energy through the body, thus creating a form that was a physical manifestation of Taoist thinking.
Going back even further, we can see the ancestors of Taiji. Hua Tuo created a system of exercise to improve digestion and circulation function of human body, based on the movements of animals and birds in the third century. The character of this system was to move every part of the body. In the sixth century, Buddha dharma visited the Shao Lin monastery and developed a system of exercise for the monks, who were in poor physical condition because of too much meditation. This was known as the Eighteen Form Lohan Exercise. Later, in the eighth century, this was developed into a 37-form ¡°Long Kung-Fu¡±, which, unlike other styles of Kung-fu, was based upon a ¡°soft¡± or internal approach, rather than a ¡°hard¡± external one.
Modern non-violent Taiji as a form on its own, rather than being a part of martial art, was developed much later, as the need for combat gradually decreased, although the Taiji practitioner is always aware that the forms that he is using are the same as those of combat, but slower. The Chen style contained jumps, leaps and explosion of strength all within a circular path. The Yang style, formulated in the mid-l9th century, is more soft, however the most popular system.2
¡°Taijichuan¡±, the original combat form of Taiji translated by words means Supreme Ultimate Fist, but the word ¡°Taiji¡± actually was one of the various changeable energy states or situation of description of universe, such as ¡°Huang Ji¡±, ¡°Yuan Ji¡±, ¡°Wu Ji¡± and etc. The ¡°Taiji¡± was born from ¡°Wu Ji¡±, in the moment between motion and still transforming, or separating to ¡°Yin and Yang¡±.1 Now we used the word ¡°Taiji¡± as the name of a combat form or a fitness exercise. Unlike many other martial arts, which were ¡°aggressive¡± or outward, the main principle of Taiji was that of a ¡°soft¡± combat - absorbing the opponent¡¯s aggressive energy and using it against him. This is a principle of ¡°Yin and Yang¡±, a balance of opposites where the soft is used to overcome the hard, as described in the maxim ¡°using a force of four ounces to defeat that of a thousand pounds¡± or ¡°overcome a weight of a thousand carries by a force of four ounces¡±. Imagine an opponent twice your weight throwing a powerful punch - the Taiji adept would step back and absorb the punch by grasping the fist and pulling it past him, using his opponent¡¯s own forward energy and motion to overbalance the attacker. Or he might respond in any number of ways, always using the same principles.
So if we want to understand more about Taiji, we should know the essence of Chinese philosophy and culture as following key points of view.
¡°Tao is action---Only vague and intangible. Yet, in the vague and void, there is image, there is substance; within the intangible there is essence, there is marrow; this essence is real. Within this real being, there is validity, trust and information.¡±6
¡°There is something evolved from void and born before the making of heaven and earth. It is inaudible and invisible. It is independent and immutable. It is forever orbiting. It is the parents of all things of heaven and earth.¡± 6
The Chinese ancient philosophy considers that there is intangible energy called Qi (or Chi) full of the universe, no matter the object is large or small. This is an important content of Chinese culture. It suggests ¡°Qi¡±, a concept that sometimes is referred to special energy, has features of energy, image, material, essence, information and consciousness. Qi exits in the entire universe and is considered to be the basic unite of everything in the universe. Qi is the most essential substance making up the world and Qi generated everything in the universe. Therefore, Qi is the root of myriad of things and everything has the spirit Qi. It seems like the astronomic theory: before anything was created, the universe was in a chaos state at first, called ¡°Wu Ji¡±; when it separated to Yin and Yang, it became the ¡°Taiji¡± state, like the fog and dew, then created all things. That is ¡°Tao engenders One, One engenders Two, Two engenders Three, and Three engenders ten thousand things¡±.6 As a part of the universe, the human body is related with universe as one union. It is believed that through the systematic discipline (mental, moral and physical) human being could accumulate Qi and cultivate potential ability to achieve health, intelligence and longevity.5
Under this philosophy, the Taiji was created and developed; it is incorporates of therapy and fitness, but always dealing with the Qi principle. It conceives that a person not only has a physical body, but also has an intangible energy body--Qi system (meridian system, aura etc.) enclosed in correlation with one¡¯s spirit. Based on this background, the Taiji practitioners should understand this philosophy first, then learn physical postures combining with mind and breath training, which called ¡°Xin Fa¡± ( main principle of mind-body harmonious practice technique) . For most persons it is hard to understand how the invisible Qi circulation in the body and how exchanging energy and message between the human body and the universe.
PUBLIC SIMPLIFIED PRACTICE PROGRAM
1. Principles for Taiji practice
The main principle of Taiji originated from traditional Chinese philosophy is the holistic harmony and the balance of Yin and Yang. The main purpose of Taiji practice in modern society is to achieve health benefits and longevity by balancing Yin and Yang in order to reach holistic harmony. Variations related to the principles of Taiji practice exist, but the following principles are central to gain more benefits even beyond health purpose.
¡°Stand like a balance and move like a wheel¡± (Wang
When you are standing you should be great stable like a balance, when you are moving you should be great flexible like a wheel. In this way of Taiji training, you can gradually get ride of rigid and obtain flexibility in body, mind and personality. Each body part moves like a wheel turning smoothly and stably and any individual movement of body part is accompanied and counterbalanced by the rest of movements of other parts. In each movement, every part of the body should be light, agile and strung together and each movement is slow but continually fluidic, endless but independent, and effortless but powerful.
¡°Suspend head, relax shoulder and sink elbow, and concentrate on Dantian ( Qi sinks in Dantian)¡± (Wu Yu-Nang) 7
Suspend head to keep the head straight and upward as if there is an invisible thread fixed at Baihui (meridian point GV20 on the top of head)5 and lightly lifting the head up throughout neck and trunk. Only when you relax shoulder and sink elbow, can you sinks Qi in Dantian, which is located just below the navel in the lower abdomen. This is ideal way to harmonize the upper with the lower of the body, and void & soft with hard & solid. In this way, you can naturally relax the whole body and mind, and facilitate both the energy circulation inside the body and the energy exchange between the body and the universe.
The waist is the commander of body movements 7
A subtle attention should be always paid to the waist to achieve a real relaxation with extremely stable and flexible movements of the whole body, because the energy center (Dantian) is in waist area of the body, and the whole body movements are initiated from the waist area. The waist movement directs the movement of other parts of the body like a commander and also leads the energy flowing to the whole body. It could make the real combination of movement and tranquility. Movement and tranquility are always accompanied each other. ¡°It represents a balance, in which movement is characterized by tranquility and tranquility is represented by movement.¡±(Wu Yu-Nang). 7
¡°Keep mind calm when body moving¡± (Wu Yu-Nang) 7
During Taiji practice, the body is moving, but the mind is always calm. The mind is the general commander. Only when the mind is calm, can it intelligently command the movement of the body. One draws the energy up from the earth through the Yongquan ((meridian point K1 on the bottom of the foot),5 and the waist directs the flow of energy to the head and limbs like water flowing through a garden hose. In addition, powerful mind may ensure a stable and peaceful body movement. On the other hand, skillful and natural body movement may improve mind power.
Taiji is also a special moving meditation
Taiji is considered a form of meditation with slow body movement, deep breathing exercise, energy guidance and mind adjustment. Taiji is sometimes called a moving meditation or Chinese moving yoga because it integrates and coordinates the body, mind, energy or power potent and conscious or subconscious function into a single whole. Especially, natural, deep and even breathing is required, and conscious and subconscious function is trained to be coordinated. Mind is the director and energy is the guide, so mind governs energy and energy leads the body movement (Wu Yu-Nang). 7
In summary, ¡°by applying the inside energy and power to the whole body, all the movements of bending or pulling and stretching or pushing of Taiji actually lead to continuous collecting and releasing of energy. This is only a cultivation of energy through a closing or filling/opening or emptying activity to achieve health and longevity¡± (Chen Xin). 7
2. Twenty Four Forms Style8
Form 1. Commencing Form
Form 2. Part Wild Horse¡¯s Mane on Both Sides
Form 3. White Crane Flashes Its Wings
Form 4. Brush Knee on Both Sides
Form 5. Strum the Lute
Form 6. Curve Back Arms on Both Sides
Form 7. Grasp the Bird's Tall-Left Style
Form 9. Single Whip
Form 10. Wave Hands like Clouds - Left Style
Form 11. Single Whip
Form 12. High Pat on Horse
Form 13. Kick with Right Heel
Form 14. Strike Opponent's Ears with Both Fists
Form 15. Turn and Kick with Left Heel
Form 16. Push Down and Stand on One Leg - Left Style
Form 17. Push Down and Stand on One Leg - Right Style
Form 18. Work at Shuttles on Both Sides
Form 19. Needle at Sea Bottom
Form 20. Flash Arm
Form 21. Turn to Deflect Downward, Parry and Punch
Form 22. Apparent close-up
Form 23. Cross Hands
Form 24. Closing Form
THE REAL FITNESS AND THERAPY PRINCIPLE
Based upon the Western view of human anatomy and biology, a practitioner may only accept a human being as a solid body, which contains many systems and organs made by different cells. However, according to the exploration of the human being¡¯s potential ability, TCM philosophy recognizes that a human being not only has a solid body, but also has an intangible energy body (meridian system, aura and energy system, etc).4
We will now use an example to illustrate the way TCM philosophy looks at the body, and how it is different from the Western. From Western understandings, according to the laws of dynamic and mechanical analysis, the organs inside the human body could not keep their regular position suspending in the cavity space of the body like blooming flowers or satellites in the universe, and would prolapsed if only relying on the integrity of muscles and tendons. So the question is: what force holds these organs in place all the time with their active functions? TCM philosophy said that it is the bio-energy field that holds every thing together in the proper place. Without the support of the energy field in cavity space, organs will prolepses, and eventually wither and die. To the TCM practitioners, the force of the energy field is as inherent as the force of the cosmic that holds the stars suspending in the universe. Every one knows that all plants on the earth are not only relying on the water and nutrition from earth but also on the photosynthesis of chlorophyll in leaves reacting with the sunlight, the energy from the universe. TCM philosophy believes that like plants, human beings have the similar condition to exchange the energy with the universe for vital life working by subconscious mind.
This basic principle of Taiji is greatly influenced by the ¡°Yellow Emperor¡¯s Classes of Internal Medicine¡±. It said: ¡°Train your mind in a quiet, calm and void statue, keep your conscious deep inside, how could you involve an illness?¡±4, which means human being could prevent all diseases and achieve self-healing by balancing Yin and Yang, and improving the energy circulation of our body.
Within our solid body there are many spaces. Traditional Chinese Medicine named four big spaces: 1) the chest space between spine and chest ribs (called Upper Jiao); 2) the upper abdomen space between diaphragm and navel (called Middle Jiao); 3) the lower abdomen space between navel and pubis (called Lower Jiao); 4) the back space between spinal column and organs, from the top of head to coccyx (called Back Jiao). These spaces seem empty and void, but actually full of invisible energy fields like the universe space.9,10
Both Western and Eastern medicine share the cell theory. The cells open to emit the energy out to space and close to absorb the energy from the space. The human body is like a universe, called ¡°small universe¡±. The cavity space is full of various kinds of energy, which congregates, collides, emerges, activates, circulates and reacts to generate even newer energy. This is the human being¡¯s intangible body, including aura light, meridian system, inside-organ light, etc. The energy in the space forms an energy field like magnetic or gravity fields. The density and characteristics of the energy field influence the activities of cells and finally the health condition.9,10
TCM has recognized that the energy field in the body space greatly influences the health condition of human beings. The influence is very simple and follows strictly the law of physics, diffusion theory. What ever is in higher concentration gradient will eventually diffuse into an area of low concentration gradient. If the density of the energy field in the space outside the organ is too high, the energy existing inside cells cannot be emitted to the space, because the law of physics would not allow that to happen. If the energy cannot be emitted out, the cells would not open properly, which in turn will cause the stagnation of the energy and retention of damp and heat inside the cells or organs. Further, this may cause the inflammation and/or even the mutation of the cells, eventually developing into cancers.
If the density of the energy field in the space outside the organ is too low, it is easy for the cells to emit the energy from inside to the space, but difficult to absorb the energy from the space to inside. This will result in the lack of energy of the organ showing weakness and low function of the organ. This theory is a new development of TCM, which can be called ¡°Body Space Medicine¡± and greatly promote the further development of TCM.10
The therapeutic techniques of TCM, such as some Chinese herb prescriptions, can change the energy pressure of body space to promote lucidity ascending and turbidity descending, and use the energy radiation of cell colonies as dynamic force to wholly improve human function and health condition. By the method of TCM treatment, the pressure difference and consistency difference of body space energy are increased to form a sharp contrast between void and solid, which will further reach ¡°extreme solid and extreme void¡± statue to induce energy movement with high speed, strong collision among cells and great change in the energy field. As a result, energy circulation becomes smooth, human body returns to naturally normal condition.10 With the similar principles, the Taiji practice also can help people like this.
For example: how to help the patients with liver problems? According to the theory and healing methodology of TCM, 10 if something is wrong (usually caused by energy stagnation) in liver, the liver will not be treated directly. Instead, the stagnating energy in the space (the high energy zone) around the liver will be not only cleaned, but also utilized at the same time. Because TCM has recognized that the stagnating energy around the liver is a potential dynamic energy, which, during its movement, might able to generate a kind of promoting force to exert the following beneficial effects: (1) promoting and activating the cells around heart, called ¡°wood can produce fire¡±; (2) promoting the movement of diaphragm, which plays an important role in the adjustment of lucidity ascending and turbidity descending; (3) enhancing liver function, which further promotes the returning circulation of hepatic portal veins. Therefore, TCM can intelligently and fully utilize the dynamic energy produced by adjusting the energy stagnation. With similar therapy strategy, Taiji also can play an important role in health improvement. The function of cell energy follows the ¡°Entropy¡± principle of the thermodynamics.
The energy stagnation inside cells is called ¡°Positive Entropy¡±, which can¡¯t be utilized. The cells could only emit this energy giving to other organs and benefiting them, and then the cells will empty themselves, which is called ¡°Negative Entropy¡±. Only in this situation can the cells absorb the energy from outside and utilize it. This natural principle is completely similar to the Christian philosophy: to give and to receive. The more you give, the more you will get. 9,10
Therefore, Life is simply the activation, circulation and exchange of the energy. If the movement of energy stops, the life will end. If the movement of energy is stagnating in some parts, these parts of the body will get diseases. The original reason for illness is not the infection of microorganism such as bacteria and viruses, but the energy stagnation. The infection of viruses is the result of the energy stagnation for a period of time. For example, at the early stage of lung infection diseases there is no microorganism existing in the lung, but the density of energy in chest space is abnormally high and the energy inside lung cells is stagnating. In this condition for a while, microorganism will appear. So TCM treats the patient holistically with emphasis on preventing and self-healing strategy. In most cases, TCM does not directly attack the abnormal organs or parts like the allopathic, but adjusts the whole body to reinforce the energy circulation in the abnormal area. 10
From the point of view of martial arts, every posture of original Taiji has probably some special meaning about fighting. But in modern society, we are more concentrated on the health purpose of Taiji. So the following discussion emphasizes on ¡°Xin Fa¡± (the main principle of mind-body practice technique for mind training) of Dao Yin (use the mind to guide the Qi movement ) related to fitness and therapy beyond the original meaning.
The Commencing Form requires relaxing the whole body, breathing evenly, slowly, deeply and smoothly, calming mind, imaging your body empty, loose and melted with universe, waiting for the energy push your hands up and exchange the energy with the outside by skin pores. It is important to get rid of burdens from the regular life and go into the special Taiji training state in the beginning.
The hold-ball gesture is one of the most basic gestures and appears many times in the whole Taiji routine. Holding a concentrated Qi ball between two hands in front of abdomen (Lower Jiao) or chest (Upper or Middle Jiao) can strengthens the energy in the Dantian area which is vital sea of human energy or strengthens the energy in the chest by utilizing the outside energy field.
According to experiment and research, there are six meridian channels starting or ending on each hand, which are connected with the whole body. There is a strong energy field around the hands. When the hands are moving through or staying beside some part of the body, they will influence the energy field of the body space, which will be stroked and changed.
the Taiji movement, following the hand posture change, the energy function of corresponding organs will be adjusted. For instance, the Brush Knee on Both Sides (Form 4) will adjust the Qi circulation on the shoulders, neck, head, ears and knees; the Grasp the Bird¡¯s Tail (Form 7) will adjust the Qi circulation of Three Jiaos£¨Triple Energizer£©in the chest, upper and lower abdomens, especially benefiting heart and kidneys; the Single Whip (Form 9) could open the Bai Hui to exchange the energy with the universe and help the energy circulation of liver ; Wave Hands Like Clouds (Form 10) are mostly beneficial for the head, face and all organs on the face; Push Down and Stand on One Leg (Form 16) may let the energy of the universe connect and go through the body, especially benefiting kidneys; Cross Hands (Form 23) and Closing Form (Form 24) keep the energy storing in the body.
Of course the Taiji program has a holistic function for fitness and therapy and is not separate for special part or organs, but we can select some individual posture for at-a-standstill training.
Some Suggestions for Taiji Practitioners
For the health purpose, we pay more attention to the fitness and therapy function of Taiji, the methods and requirements of Taiji practice are somewhat different from martial arts.
THE SCIENTIFIC RESEARCH EVIDENCE
Taiji, though practiced for balancing mind and body to cultivate physical and psychological health benefits in China for hundreds of years, has only recently gained the interest of researchers in Western countries as an alternative form of exercise. There is a steady increase in scientific research documenting the benefits of Taiji.11
Literature reviews published between 1999 and 2001 began to offer conclusions based on review of clinical study from a discipline or a focused clinical area perspective. Chen and Snyder12 reviewed the growing evidence assessing Taiji as a potential nursing intervention. As a result of their 1999 review, Chen and Snyder12concluded that Taiji practice had demonstrated benefits of balance improvement, falls prevention, cardiovascular enhancement, and stress reduction.
In a 2001 publication, Li et al13 reviewed 31 topic-related articles, including both controlled experimental clinical trials and descriptive or case control studies, designed either to assess physiologic response or general health and fitness effect of Taiji practice. These authors concluded that Taiji is ¡°a moderate intensity exercise that is beneficial to cardiopulmonary function, immune capacity, mental control, flexibility, and balance control; it improves muscle strength and reduces risk of falls in the elderly.¡± 13 Fascko and Grueninger14 confirmed conclusions of Li et al13 after an extensive review of relevant literature assessing the effects of Taiji on physical and psychological health that included over 30 topic-related articles published before 2001.
In March 2004, Wang et al15 published a systematic review of Taiji as a therapeutic intervention for chronic conditions. They reviewed 9 randomized critical trials, 23 nonrandomized controlled studies, and 15 observational studies. The authors¡¯ conclusions include that Taiji has physiological and psychosocial benefits and also is safe and effective in promoting balance control, flexibility, and cardiovascular and respiratory function in older patients with chronic conditions.
Most recently, a critical review by Klein et al11 has offered an update on the current breadth and strength of research evidence regarding comprehensive therapeutic benefits of Taiji practice. Controlled research evidence was found to confirm therapeutic benefits of Taiji practice with regard to improving quality of life, physical function including activity tolerance and cardiovascular function, pain management, balance and risk of falls reduction, enhancing immune response, and improving flexibility, strength, and kinesthetic sense. Figure 2 illustrates the distribution of therapeutic effect revealed in the 17 studies included in this critical analysis.11 Of the dependent variables examined in controlled research, improved indicators of quality of life were most often assessed and validated. Quality of life is a complex construct encompassing multiple and overlapping domains of life function. The effects related to general health and wellness, psychological, social, cognitive, and behavioral foci were grouped together under the collective subheading of quality of life. The second most frequently studied beneficial effect was improved physical function.
According to the critical analysis by Klein et al11, of the >300 topic-related articles identified through electronic search of the literature, >200 of those titles were judged to be original, topic-relevant scholarly or scientific reports. Of >200 published reports examined, 17 controlled clinical trials16-31 were judged to meet a high standard of methodological rigor. A chronological descriptive analysis of dates of publications, the number, and the design rigor categorized as levels I-IV (controlled clinical trials; randomized clinical trials; observational case studies, pilot studies; and one group trials) evidence reveals that the amount and strength of research evidence has exponentially increased in the past 5 years. Topic-related output within that time period has more than doubled the output for the previous 20 years (Figure 3).11 Geographic distribution of publications examined includes scientific studies conducted in the United Kingdom, United States, Canada, Australia, Israel, China, and South Korea, etc, showing the global clinical and research interest is evident within this body of published literature.
Within the larger body of scientific reports and clinical studies including levels I-IV, a variety of clinical populations were studied. These include children with attention deficit,32 adults with cardiac dysfunction, 17,33,34 and individuals with rheumatoid arthritis,35-37 fibromyalgia,38 chronic back pain,18 osteoporosis,39,40 hemophilia,41 osteoarthritis,19,42 ankylosing spondylitis,43 Alzheimer¡¯s disease,44 multiple sclerosis,45,46 head trauma,47 Parkinson¡¯s disease,48 acquired immunodeficiency syndrome,44 and immune vulnerability.20
A total of 1,035 subjects participated in the 17 research studies included in the critical review by Klein et al.11 Demographic distributions consisted of at least 70% of the subjects being older adults, 60% or more were women, and >80% of subjects represented non-clinical populations. Taiji intervention most often conformed to characteristics of Yang style49 and most often included simplified forms modified from the traditional Yang style 108 (movements) forms.52 The lengths of Taiji intervention training ranged from 6 weeks to 12 months. Frequencies of supervised intervention ranged from once to three times weekly. Activity duration ranged from <15 minutes to >1 hour per session.
The Taiji groups did so well in all these clinical trails that an article in the Journal of the American Geriatrics Society recommended Taiji as a low-technology approach to conditioning that can be implemented at relatively low cost in widely distributed facilities throughout the community.51
Beneficial effects on the cardiovascular and pulmonary system
Taiji exercise has recently gained the attention of Western researchers as a potential form of aerobic exercise52 The aerobic capacity provides important information about cardiopulmonary function. The effect of Taiji exercise on aerobic capacity is important to know if clinicians want to recommend Taiji as an alternative form of aerobic exercise.
A study by Lai et al53 found that the elderly Taiji exercisers showed a significant improvement in oxygen (O2) uptake compared to an age-matched control group of sedentary elders. Lai and colleagues concluded that the data substantiated the practice of Taiji as a means of delaying the decline in cardiopulmonary function commonly considered ¡°normal¡± for aging individuals. In addition, Taiji was shown to be a suitable aerobic exercise for older adults.53 Another study by Lai et al54 substantiated that Taiji exercise is aerobic exercise of moderate intensity. The other cardiovascular study comparing elderly Taiji practitioners with a sedentary group also found that ¡°the Taiji group showed 19% higher peak oxygen uptake in comparison with their sedentary counterparts.¡±55
In a year-long clinical trial,34 individuals who had recently undergone coronary bypass graft surgery (n = 20) were non-randomly assigned to either a Taiji practice group or a home-based exercise group after completion of an aerobic cycling cardiac phase II exercise program. The Taiji group members were found to exercise at an intensity of 48-57% maximum heart rate range. Graded exercise tests performed before and after 1 year of intervention found that those in the Taiji group showed significant increase in O2 peak (10% increase) and peak work (12% increase) as compared with control group.
One intriguing finding of the current research has to do with evidence of conditioning effect at low training heart rates. Young et al22 reported that, in a randomized control study, individuals exercising regularly performing Taiji with mean exercising heart rate of 75 beats/min had the similar beneficial cardiovascular response related to decreased resting systolic blood pressure (mean change, 7.0 mm Hg for resting systolic blood pressure) as compared with a comparison group who participated in a walking program at a mean heart rate of 112 beats/min (mean change, 8.4 mm Hg for resting systolic blood pressure).
In another cardiac-related study,17 an 8-week randomized clinical trial (n = 126) was conducted to evaluate the effect of Taiji practice for individuals with recent myocardial infarct. Results revealed that both the aerobic exercise group and the Taiji group had trends in reduced systolic blood pressure, but only the Taiji group showed trends of reduced diastolic blood pressure, suggesting that Taiji practice outcomes may be mildly superior to aerobic exercises programs for this clinical population. The beneficial effects of Taiji on blood pressure and lipid profile and anxiety status have been shown in a randomized controlled trial of a Taiji group and a group of sedentary life controls (totally 76 healthy subjects with blood pressure at high-normal or stage I hypertension).56 After 12-week of Taiji training with a frequency of 3 times per week, as compared with controls, the treatment group showed significant decrease in systolic blood pressure of 15.6 mm Hg and diastolic blood pressure 8.8 mm Hg. The serum total cholesterol level decreased 15.2 mg/dL and high-density lipoprotein cholesterol increased 4.7 mg/dL. Both trait anxiety and state anxiety were decreased. This study shows that under well-designed conditions, Taiji exercise training could decrease blood pressure, result in favorable lipid profile changes and improve subjects¡¯ anxiety status, suggesting that Taiji could be used as an alternative modality in treating patients with mild hypertension, with a promising economic effect.56
The collective research evidence, with respect to cardiovascular rehabilitation applications, supports that Taiji practice is a safe, effective, low-intensity exercise regimen suitable for use as an exercise option with this vulnerable clinical population. Although the mechanism of effect is not fully understood, the possibility of increasing aerobic capacity without stressing a compromised cardiac system is desirable. Although collaborating clinical research is needed, there is theory-based rationale to generalize these conclusions to pulmonary rehabilitation as well.
Balance improvement and falls prevention
One of the challenges faced by people with advancing age is decreased postural stability and increased risks for falls. There has been an increased interest and research over the last decade in using Taiji as an intervention exercise for improving postural balance and preventing falls in older people.57-61
Improved balance is one of the most commonly attributed benefits of Taiji practice. One of the earliest well-known studies addressing this effect comes from a correlation study.15 In the article published in 1992, Tse and Bailey62 reported balance abilities among experienced Taiji practitioners observed to be superior to balance abilities among sedentary subjects. This early work has become part of the justification for the belief that Taiji practice had potential use in falls reduction programs. The findings in a controlled clinical study by Tsang et al63 indicated that even 4 weeks of intensive Taiji training are sufficient to improve balance control in the elderly subjects. These improvements were maintained even at follow-up 4 weeks afterward. Furthermore, the improved balance performance from week 4 on was comparable to that of experienced Taiji practitioners. A randomized controlled study by Jacobson et al30 observed improved lateral balance stability in healthy volunteer adults (n = 24) after just 12 weeks of Taiji practice.
In a prospective controlled clinical study (n = 38), Lan et al28 observed improved time on balance in the Taiji group as compared with controls. Subjects were older adults, and the study was conducted over a 12-months period. The mean frequency of practice was 4.6 times per week. The style of Taiji practiced in both studies was the 108 Yang form. Another randomized controlled trial showed that 6 months of low intensity Taiji training could maintain the beneficial effects on balance and strength of 3 months of intensive balance and/or weight training.64 Subjects were 110 healthy community dwellers (mean age 80). Significant gains persisted after 6 months of Taiji training. Most recently, in a 2005 publication by Tsang et al65, the results demonstrate that long-term Taiji practitioners had better knee muscle strength, less body sway in perturbed single-leg stance, and greater balance confidence. Significant correlations among these three measures uncover the importance of knee muscle strength and balance control during perturbed single-leg stance in older adults¡¯ balance confidence in their daily activities.
Research evidence supporting clinical use of Taiji in the areas of falls prevention comes in major part from the well known multiple-center FICSIT (Frailty and Injuries: Cooperative Studies on Intervention Techniques) studies.23,24 The Atlanta group of the federally-funded, prospective FICSIT study randomly assigned community-dwelling older adults (n = 200) to one of three groups: a 15-week course of Taiji exercises, computerized balance training, or education (control). Subjects were grouped in cohorts of 10-12. The Taiji groups met twice weekly, and the balance training and control groups met once weekly. Biomedical, functional, and psychosocial outcome variables were measured immediately and 4 months post intervention. Although improvements in physiologic response to exercise were found in the Taiji group, the most cited finding of the follow-up study report24 is a 47% reduction in falls risk or delay of next fall in the Taiji group.
Whereas the FICSIT studies suggested reduction of falls, a more recent randomized clinical trial (n = 163) conducted in Australia provides primary evidence. Barnett et al66 randomly assigned community dwelling elders known to have a risk of falling to either a control or a Taiji exercise group. The Taiji intervention consisted of weekly group instruction in Taiji combined with daily home practice. Physical performance and general health measures were assessed through repeated measures. After 1 year of Taiji practice, the experimental group was found to have a 40% reduction in falls. Furthermore, in a 6-month randomized controlled trial (n = 256), Li et al67 concluded that improved functional balance through Taiji training is associated with subsequent reductions in fall frequency in older persons.
Recently, the potential benefits in healthy younger age cohorts and for wider aspects of health have also received attention. The study by Thornton et al68 documented prospective changes in balance and vascular responses for a community sample of middle-aged (33-55 years) women (n = 34). Dynamic balance measured by the Functional Reach Test was significantly improved following 12-week Taiji exercise program (three times per week), with significant decreases in both mean systolic (9.71 mmHg) and diastolic (7.53 mmHg) blood pressure, compared with sedentary control. The data confirm that Taiji exercise can be a good choice of exercise for middle-aged adults, with potential benefits for ageing as well as the aged.
Pain management in chronic back pain and osteoarthritis
Taiji practice has been shown to be effective in pain management. Bhatti et al18 reported preliminary findings of a randomized clinical trial (n = 51) investigating the efficacy of Taiji practice as a strategy to manage chronic pain. Adult subjects with long-standing diagnosis of chronic back pain were assigned to either a control group or a Taiji exercise group. Study results after 6 weeks of Taiji practice revealed significant reductions in average, lowest, and worst pain experienced in the last week, measured on a visual analog scale, and self-reported improvements in mood.
Osteoarthritis (OA) is the most common form of arthritis in the United States and causes functional limitations and pain that worsen an individual's quality of life. While reducing the pain associated with OA is an important consideration in managing OA. In a randomized clinical trial of adults with lower limb OA (n = 33), Hartman et al19 found that after 12 weeks of twice-weekly supervised exercise sessions, subjects in the Taiji group reported significant increases in self-efficacy for arthritis symptoms and improved satisfaction with general health as compared with controls. Similarly Adler et al21 demonstrated, in a pilot study, that pain intensity scores for individuals (n = 16) with chronic arthritis pain decreased as compared with controls. The experimental intervention employed was a 10-week program of once-weekly supervised Taiji exercise.
The safety of Taiji on rheumatoid arthritis (RA) patients was evaluated in a study (n = 55) by Kirsteins et al.36 RA patients, who received 1 hour of Taiji instruction once and twice a week for 10 weeks in two separate studies, showed no deterioration in their clinical disease activities compared with the corresponding controls. No significant exacerbation of joint symptoms using this weight-bearing form of exercise was observed. Taiji exercise appears to be safe for RA patients and may serve as an alternative for their exercise therapy and part of their rehabilitation program.
Improved flexibility, strength, and kinesthetic sense
In physical rehabilitation, there is agreement that a relationship can exist between a reduction of impairment and an improvement in function. Variables such as flexibility, strength, and kinesthetic sense are impairments that are associated with the complex construct of physical function. Evidence, generated through controlled clinical research, has demonstrated the beneficial effects of Taiji practice on these three variables. In addition to improvements in lateral body stability related to balance, Jacobson et al30 found significant improvements in leg extensor strength and kinesthetic sense in healthy subjects after 12 weeks of Taiji. Sun et al25 observed lower resting systolic and diastolic blood pressure and increases in shoulder and knee flexibility in older adults who participated in a 12-week program of Taiji exercises as compared with randomly assigned controls. In a prospective controlled trial (n = 36), Chen and Sun29 observed increased flexibility measured using a sit¡¯n reach box. The Taiji intervention employed in the latter study consisted of the Yang-style 24-movement form and was conducted over 16 weeks at a frequency of twice-weekly classes. Such demonstrations of beneficial changes in physical variables, often addressed as goals of physical rehabilitation, make Taiji practice an exercise intervention option with potential to achieve improved flexibility, strength, and kinesthetic sense.
Potential immune response effects
A potential immune response effect of Taiji practice is a frequent claim of Taiji enthusiasts. Preliminary evidence of this phenomenon was provided in a two-group study of Taiji practitioners who reported 6 years or more of regular Taiji practice. Xusheng et al31 found positive changes in humoral activity attributed to a single episode of practice and indications of humeral immunity associated with long-term Taiji practice.
Clinical evidence to assess the effect of Taiji practice on immune response within novice Taiji practitioners is just emerging. Both the incidence and severity of herpes zoster (shingles) increase markedly with increasing age in association with a decline in varicella-zoster virus (VZV) specific cell-mediated immunity. In a randomized clinical trial (n = 36), Irwin et al20 exposed older adults with no previous Taiji experience to 15 weeks of practice at a frequency of three times a week. Results revealed a nearly 50% increase in VZV-specific, cell-mediated immunity in the Taiji group as compared with demographically similar, wait-list controls. In addition, Taiji was associated with improvements in physical health functioning, with greatest effects in those older adults who had impairments of physical status at entry into the study. Evidence of this enhanced immune effect suggests clinical applications for the elderly who naturally experience some decline in immune response and for immune-suppressed individuals. This is an under-researched area with great potential.
Taiji augment the exercise effects through the use of both mental concentration and relaxation of tension, which are thought to benefit emotional states. The psychological benefits of Taiji practice have been shown in a number of studies26,27,69,70 and reviews.15,71
The stress reduction effects of Taiji exercise as measured by heart rate, blood pressure, and urinary catecholamine, and salivary cortical level were compared with groups of brisk walking, mediation and quiet reading in a randomized controlled trial (n = 96) by Jin et al.27 In general, it was found that the stress-reduction effect of Taiji characterized those physiological changes produced by moderate exercise. Heart rate, blood pressure, and urinary catecholamine changes for Taiji exercise group were similar to those changes occurring in the walking group. Additionally, Taiji group expressed enhancement of ¡°vigor¡± and a reduction in anxiety states.
In a randomized controlled trial (n = 118), Li et al72 reported significant improvement in self-rated sleep quality in older adults with moderate sleep complaints who participated in a 24-week program of Taiji exercises (a 60-minute session, three times per week) as compared with low-impact exercise controls. Taiji appears to be effective as a non-pharmacological approach to sleep enhancement for sleep-disturbed elderly individuals.
Summary and future prospect
The scientific literature validating the physical and physiologic therapeutic effects of regular Taiji practice has grown exponentially over the past 5 years. The documented range of benefits validates the attribute of comprehensiveness of effect. The research evidence supports benefits of improved quality of life; physical function including cardiovascular, pain management, balance, and risk of falls reduction; enhanced immune response; and improved flexibility, strength, and kinesthetic sense attributed to Taiji practice. Based on evidence generated from controlled clinical trials, Taiji program exploration is justified in the areas of cardiac rehabilitation, chronic pain management, falls prevention programs, and health and wellness intervention for individuals who are immune suppressed and for fitness exercise programs for the elderly and individuals with exercise precautions due to arthritis-related conditions. Applied theory and preliminary research serve as justification for future controlled clinical study of the benefits of Taiji intervention with individuals with neurological disease: particularly multiple sclerosis, Parkinsonism, neurodevelopmental motor performance dysfunction, pulmonary insufficiency, and systemic musculoskeletal disorders. It is anticipated from existing research and the mind/body theoretical model that potential benefits from Taiji practice could be expanded to include both physical and behavioral applications.
Although the most of western people know Taiji as a traditional Chinese physical exercise, indeed it is a kind of traditional Chinese Yanshenshu (a mind-body harmony technique for health improvement and longevity), an important part of Traditional Chinese Medicine, when it is practiced with Taiji principles (the natural principles for harmonizing body and mind). The scientific literature validating the physical and physiologic therapeutic effects of regular Taiji practice has increased exponentially.
After practicing Taiji, the most of people realize that Taiji is not a regular physical exercise but a special body-mind training technique, which is closely related to traditional Chinese philosophy, culture and medicine. The relation between human body and mind as well human beings and the natural environments is greatly emphasized in Taiji. According to TCM literatures, ¡°the advanced doctors would like treat patients before their symptoms become detectable¡±.4 Taiji, as a part of TCM, has been effectively applied in most of oriental countries for hundreds of years. It is a wiser, easier, more economic, convenient and effective medicine.
How much benefit a practitioner gets from the Taiji practice depends on how much he understands the Taiji philosophy and practices it correctly. Since the former is much more important than the latter, more details on Taiji ¡°Xin Fa¡± (main principle of mind-body practice technique for mind training) are introduced in this chapter. Hopefully, readers are able to get more benefits from Taiji practice after reading this chapter.
Following Taiji principle, human beings could self-cultivate and reinforce the defensive system to prevent diseases and improve health through adjusting inner bio-energy circulation, and harmonizing body and mind with the universe. According to an official statistics, China, where most of people following the oriental health principle and utilizing TCM including Taiji , used only about 1% of the health care expense of the world to manage about 22% of population of the world.73 On the other hand, a great part of GTP is used for health care in most of western countries. According to AMA report,74 about 6~7% of GTP (about 1.3 trillion USD/year) was used for health care in the United States in the most recent years. If more western people apply Taiji as a complementary and alternative health care technique, they will achieve lots of benefits.
1. Sophia Delza: Taiji Chuan, State University of New York press, 1985
2. Gu Liushen: Taijiquan Technique, Shanghai Educational Publishing House, China, 1982
3. Yuan Fuquan: The historical origin of Taijiquan has been discovered after misunderstood for hundreds of years. ¡°Da He News¡±, China, March 26, 2005
4. Veith Ilza: The Yellow Emperor's Classic of Internal Medicine / translated. Berkeley and Los Angeles, California, University of California Press, 2002
5. Cheng Xinnong: Chinese Acupuncture and Moxibustion, Foreign Languages Press, Beijing, China, 1987
6. Burton Watson: LAO-TZU Tao Te Ching, Hackett Publishing Company, 1984
7. Yu Jianbao: Taiji Healthy Express, Chinese Tourism Publishing House, China, 2005
8. China Sports Magazine: ¡°Simplified Taijiquan¡±, People¡¯s Spots Publishing House of China, 1999
9. Guo Zhicheng: Chinese Intelligent Medicine, Hua-Shen Publishing House, China, 1992
10. Guo Zhicheng: The Introduction of Body Space Medicine. 4th Annual CAMera Research Sysposium -Building CAM Research:Case by Case, Edmonton, Canada, June, 2005
11. Klein PJ, Adams WD: Comprehensive therapeutic benefits of Taiji: A critical review. Am J Phys Med Rehabil 2004;83:735-45.
12. Chen K, Snyder M: A research-based use of Tai Chi/movement therapy as a nursing intervention. J Holistic Nurs 1999;17:267-79
13. Li F, Harmer P, McAuley E, et al: An evaluation of the effects of tai chi exercise on physical functioning among older persons: A randomized clinical trial. Anal Behav Med 2001;23:139-46
14. Fascko D, Grueninger W: T¡¯ai Chi Ch¡¯uan and physical and psychological health: A review. Clin Kinesiol 2001;55:4-12
15. Wang C, Collet JP, Lau J: The effect of Tai Chi on health outcomes in patients with chronic conditions: A systematic review. Arch Intern Med 2004;164:493-501
16. Lumsden DB, Baccala A, Martire J: T¡¯ai chi for osteoarthritis: An introduction for primary care physicians. Geriatrics 1998;53:84-8
17. Channer K, Barrow D, Barrow R, et al: Changes in hemodynamic parameters following Tai Chi Chuan and aerobic exercise in patients recovering from acute myocardial infarction. Postgrad Med J 1996;72:349-51
18. Bhatti TI, Gillin JC, Atkinson JH, et al: T¡¯ai Chi Chih as a treatment for chronic low back pain: A randomized, controlled study. Proceedings of the Third Annual Alternative Therapies Symposium Creating Integrated Healthcare, San Diego, April 1-4, 1998. Am Assoc Crit Care Nurs 1998;7:216-8
19. Hartman CA, Manos TM, Winter C, et al: Effects of t¡¯ai chi training on function and quality of life indicators in older adults with osteoarthritis. J Am Geriatr Soc 2000;48:1553-9
20. Irwin MR, Pike JL, Cole JC, et al: Effects of a behavioral intervention, Tai Chi Chih, on varicella-zoster virus specific immunity and health functioning in older adults. Psychosom Med 2003;65:824-30
21. Adler P, Good M, Roberts B, et al: The effects of Tai Chi on older adults with chronic arthritis pain. J Nurs Scholarship 2000;32:7
22. Young D, Appel L, Jee SH, et al: The effects of aerobic exercise and T¡¯ai Chi on blood pressure in older people: Results of a randomized trial. J Am Geriatr Soc 1999;47:277-8
23. Wolf SL, Barnhart HX, Ellison GL, et al: The effect of Tai Chi Quan and computerized balance training on postural stability in older subjects: Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies on Intervention Techniques. Phys Ther 1997;77:371-81
24. Wolf SL, Barnhart HX, Kutner NG, et al: Reducing frailty and falls in older persons: An investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. J Am Geriatr Soc 1996;44:489-97
25. Sun WY, Dosch M, Gilmore GD, et al: Effects of Tai Chi Chuan program on Hmong American older adults. Educ Gerontol 1996;22:161-7
26. Brown DR, Wang Y, Ward A, et al: Chronic psychological effects of exercise and exercise plus cognitive strategies. Med Sci Sports Exerc 1995;
27:765-75 27. Jin P: Efficacy of Tai Chi, brisk walking, meditation, and reading in reducing mental and emotional stress. J Pyschosom Res 1992;36:361-70
28. Lan C, Lai J, Chen S, et al: 12-month Tai Chi training in the elderly: Its effect on health fitness. Med Sci Sports Exerc 1998;30:345-51
29. Chen WW, Sun WY: Tai Chi Chuan, an alternative form of exercises for health promotion and disease prevention for older adults in the community. Int Q Comm Health Educ 1997;16333-9
30. Jacobson B, Ho-Chen C, Cashel C, et al: The effect of T¡¯ai Chi Chuan training on balance, kinesthetic sense, and strength. Percept Motor Skills 1997;84:27-33
31. Xusheng S, Yugi X, Zhu R: Detection of ZC rosette-forming lymphocytes in the healthy aged with Taichiquan (88 style) exercise. J Sports Med Phys Fitness 1990;30:401-5
32. Hernandez-Reif M, Field TM, Thimas E: Attention deficit hyperactivity disorder: Benefits from Tai Chi. J Bodywork Mov Ther 2001;5:30-3
33. Fontana JA, Colella C, Baas LS, et al: T¡¯ai Chi Chih as an intervention for heart failure. Nurs Clin North Am 2000;35:1031-47
34. Lan C, Chen S, Lai J, et al: The effect of Tai Chi on cardiorespiratory function in patients with coronary artery bypass surgery. Med Sci Sports Exerc 1999;31:634-8
35. van Deusen J, Harlowe D: The efficacy of the ROM dance program for adults with rheumatoid arthritis. Am J Occup Ther 1987;41:90-5
36. Kirsteins A, Dietz F, Hwang S: Evaluating the safety and potential use of a weight-bearing exercise, Tai Chi Chuan, for rheumatoid arthritis patients. Am J Phys Med Rehabil 1991;70:136-41
37. Ng G, Yeung D: Tai-Chi Chuan Training for Rehabilitation of Rheumatoid Arthritis. Poster presentation at the 14th International WCPT Congress 2003, Barcelona, June 7-12, 2003
38. Taggart HM, Arsianian CL, Bae S, et al: Effects of T¡¯ai Chi exercise on fibromyalgia symptoms and health-related quality of life. Orthop Nurs 2003;22:353-60
39. Qin L, Au S, Choy W, et al: Regular Tai Chi Chuan exercise may retard bone loss in postmenopausal women: A case-control study. Arch Phys Med Rehabil 2002;83:1355-9
40. Prior JC, Barr SI, Chow R, et al: Physical activity as therapy for osteoporosis. CMAJ 1996;155:940-4
41. Danusantoso H, Heijnen L: Tai Chi Chuan for people with haemophilia. Haemophilia 2001;7:437-40
42. Song R, Lee EO, Lam P, et al: Effects of tai chi exercise on pain, balance, muscle strength, and perceived difficulties in physical function in older women with osteoarthritis: A randomized clinical trial. J Rheumatol 2003;30:2039-44
43. Koh TC: Tai chi and ankylosis spondylitis: A personal experience. Am J Chinese Med 1982;10:59-61
44. Briggs N: Teachers Exchange and Success Stories. Presented at Taijiquan Teachers Exchange Weekend, Douglassville, PA, October 24-26, 2003
45. Mills N, Allen J: Mindfulness of movement as a coping strategy in multiple sclerosis: A pilot study. Gen Hosp Psychiatry 2002;22:425-31
46. Husted C, Pham L, Hekking A, et al: Improving quality of life for people with chronic conditions: The example of T¡¯ai Chi and multiple sclerosis. Altern Ther Health Med 1999;5:70-4
47. Shapira MY: Tai Chi Chuan practice as a tool for rehabilitation of severe head trauma: Three case reports. Arch Phys Med Rehabil 2001;82:1283-5
48. Calkins J: Taiji and Parkinson¡¯s. Presented at Taijiquan Teachers Exchange Weekend, Douglassville, PA, October 24-26, 2003
49. Liang SY, Wu WC: Tai Chi Chuan, ed 2. Roslindale, MA, YMAA, 1996
50. Zhongwen F: Mastering Yang Style Tai Chi. Berkeley, CA, North Atlantic Books, 1999
51. Blair SN, Garcia ME. Get up and move: A call to action for older men and women. J Am Geriatr Soc. 1996;44:599-600
52. Taylor-Piliae RE, Froelicher ES. Effectiveness of Tai Chi exercise in improving aerobic capacity: a meta-analysis. Journal of Cardiovascular Nursing. 2004;19(1):48-57
53. Lai JS, Lan C, Wong MK: Two-year trends in cardiorespiratory function among older Tai Chi Chuan practitioners and sedentary subjects. J Am Geriatr Soc 1995;43:1222-7
54. Lai JS, Wong MK, Lan C, et al: Cardiorespiratory responses of Tai Chi Chuan practitioners and sedentary subjects during cycle ergometry. J Formos Med Assoc 1993;92:894-9
55. Lan C, Lai JS, Wong MK, et al: Cardiorespiratory function, flexibility, and body composition among geriatric Tai Chi Chuan practitioners. Arch Phyl Med Rehabil 1996;77(6):612-616
56. Tsai JC, Wang WH, Chan P, et al: The beneficial effects of Tai Chi Chuan on blood pressure and lipid profile and anxiety status in a randomized controlled trial. Journal of Alternative & Complementary Medicine. 2003;9(5):747-54
57. Gillespie LD, Gillespie WJ, Robertson MC, et al: Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 2003;4:CD000340
58. Wu GJ: Evaluation of the effectiveness of Tai chi for improving balance and preventing falls in the older populations: A review. J Am Geriatr Soc 2002;50:746-54
59. Gillespie LD, Gillespie WJ, Robertson MC, et al: Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 2001;3:CD000340
60. Wolf SL, Barnhart HX, Kutner, NG, et al: Selected As the Best Paper in the 1990s: Reducing Frailty and Falls in Older Persons: An Investigation of Tai Chi and Computerized Balance Training. J Am Geriatr Soc 2003;51(12):1794-1803
61. Choi JH, Moon JS, Song R: Effects of Sun-style Tai Chi exercise on physical fitness and fall prevention in fall-prone older adults. J Advanced Nurs 2005;51(2):150-157
62. Tse SK, Bailey DM: T¡¯ai Chi and postural control in the well elderly. Am J Occup Ther 1992;6:295-300
63. Tsang WW, Hui-Chan CW: Effect of 4- and 8-wk intensive Tai Chi Training on balance control in the elderly. Med Sci Sports Exerc 2004;36(4):648-57
64. Wolfson L, Whipple R, Derby C, et al: Balance and strength training in older adults: Intervention gains and Tai Chi maintenance. J Am Geriatr Soc 1996;44:498-506
65. Tsang WW, Hui-Chan CW: Comparison of Muscle Torque, Balance, and Confidence in Older Tai Chi and Healthy Adults. Med Sci Sports Exerc 2005;37(2):280-9
66. Barnett A, Smith B, Lord SR, et al: Community-based group exercise improves balance and reduces falls in at-risk older people: A randomized controlled trial. Age Aging 2003;32:407-14
67. Li F, Harmer P, Fisher KJ, et al: Tai Chi: Improving Functional Balance and Predicting Subsequent Falls in Older Persons. Med Sci Sports Exerc 2004;36(12):2046-52
68. Thornton EW, Sykes KS, Tang WK: Health benefits of Tai Chi exercise: improved balance and blood pressure in middle-aged women. Health Promotion International 2004;19(1):33-38
69. Jin P. Changes in heart rate, noradrenaline, cortisol and mood during tai chi. J Psychosom Res 1989;33:197-206
70. Ross MC, Bohannon AS, Davis DC, et al: The effects of a short-term exercise program on movement, pain, and mood in the elderly. Results of a pilot study. J Holistic Nurs 1999; 17(2):139-47
71. Sandlund ES, Norlander T: The effects of Tai Chi Chuan relaxation and exercise on stress and well-being. Int J Stress Manage 2000;7:139-49
72. Li F, Fisher KJ, Harmer P, et al: Tai Chi and Self-Rated Quality of Sleep and Daytime Sleepiness in Older Adults: A Randomized Controlled Trial. J Am Geriatr Soc 2004;52(6):892-900
73. Chen Yongjie, Jia Qian: The Diagnoses for Chinese Medicine and Herbology Development. People¡¯s Daily, Beijing, China , April 6, 2003
74. Eisenberg DM, Davis RB, et al: Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA 1998 Nov 11;280 (18):1569-75.