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Tai Chi

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: xutian1@netzero.net

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INTRODUCTION
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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 Zong-Yue)7
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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

Note:

1. In the illustrations of Fig 1, the paths of the movements to be executed are indicated by arrows drawn in solid lines for the right hand and left foot, and dotted lines for the left hand and the right foot.

2. Movement directions are given in terms of the 12 hours of the clock. Begin by facing 12 o¡¯clock, with 6 o¡¯clock behind you, 3 o¡¯clock at your left and 9 o¡¯clock at your right. Thus a turn to one o¡¯clock is one of 30 degrees to the right, and a turn to 1-1/2 o¡¯clock is one of 45 degrees.

3. The requirement of stand posture: head erect, torso straight, waist and hips relaxed, legs extended naturally, Knee in line with toes.

Form 1. Commencing Form

1) Stand upright with feet shoulder-width apart, toes pointing forward, and arms hanging naturally at sides. Look straight ahead (Fig 1-1). Points to remember: Hold head and neck erect, with chin drawn slightly inward. Do not protrude chest or draw abdomen in.

2) Float arms slowly forward to shoulder level, palms down (Fig 1- 1~2).

3) Bend knees as you press palms down gently, with elbows dropping towards knees. Look straight ahead.

Points to remember: Keep torso erect and hold shoulders and elbows down. Fingers are slightly curved. Body weight is equally distributed between legs. While bending knees, keep waist relaxed and buttocks slightly pulled in. The lower arms should be coordinated with the bending knees.

Form 2. Part Wild Horse¡¯s Mane on Both Sides

1) With torso turning slightly to the right (1 o¡¯clock) and weight shifted onto right leg, raise right hand until forearm lies horizontally in front of right part of chest, while left hand moves in a downward curve until it comes under right hand, palms facing each other as if holding a energy ball (henceforth referred to as ¡°hold-ball gesture¡±). Move left foot to the side of right foot, toes on floor. Look at right hand (Fig 1- 3).

2) Turn body to the left (10 o¡¯clock) as left foot takes a step towards 8-9 o¡¯clock, bending knee and shifting weight onto left leg, while right leg straightens with whole foot on the floor for a left ¡°bow stance¡±. As you turn body, raise left hand to eye level with palm facing obliquely up and elbow slightly bent and lower right hand to the side of right hip with palm facing down and fingers pointing forward. Look at left hand (Fig 1- 4).

3) Repeat movements in 1-2), reversing ¡°right¡± and ¡°left¡± (Fig 1- 3~4).

Points to remember: Hold torso erect and keep chest relaxed. Move arms in a curve without stretching them when you separate hands. Use waist as the axis in body turns. The movements in making a bow stance and separating hands must be smooth and synchronized in tempo. When taking a bow stance, place front foot slowly in position and heel coming down first. The knee of front leg should not go beyond toes while rear leg should be straightened, forming an angle of 45 degrees with ground. There should be a transverse distance of 10-30 cm between heels. Face 9 o¡¯clock in final position.

Form 3. White Crane Flashes Its Wings

1) With torso turning slightly to the left (8 o¡¯clock), make a hold-ball gesture in front of left part of chest, left hand on top. Look at left hand.

2) Draw right foot half a step towards left foot and then sit back. Turn torso slightly to the right (10 o¡¯clock), with weight shifted onto right leg and eyes looking at right hand. Move left foot a bit forward, toes on floor for a left ¡°empty stance¡±, with both legs slightly bent at knee. At the same time, with torso turning slightly to the left (9 o¡¯clock), raise right hand to the front of right temple, palm turning inward, while left hand moves down to the front of left hip, palm down. Look straight ahead (Fig 1- 5).

Points to remember: Do not thrust chest forward. Arms should be rounded when they move up or down. Weight transfer should be coordinated with the raising of right hand. Face 9 o¡¯clock in final position.

Form 4. Brush Knee on Both Sides

1) Turn torso slightly to the left (8 o¡¯clock) as right hand moves down while left hand moves up. Then turn torso to the right (11 o¡¯clock) as right hand circles past abdomen and up to ear level with arm slightly bent and palm facing obliquely upward, while left hand moves in an upward-rightward-downward curve to the front of right part of chest, palm facing obliquely downward. Look at right hand (Fig 1-6).

2) Turn torso to the left 9 o¡¯clock as left foot takes a step in that direction for a left bow stance. At the same time, right hand draws leftward past right ear and, following body turn, pushes forward at nose level with palm facing forward, while left hand circles around left knee to stop beside left hip, palm down. Look at fingers of right hand (Fig 1- 7~8).

3) Repeat movements in 1-2), reversing ¡°right¡± and ¡°left¡± (Fig 1- 6~8).

Form 5. Strum the Lute

Move right foot half a step towards left heel. Sit back and turn torso slightly to the right (10-11 o¡¯clock), shifting weight onto right leg. Raise left foot and place it slightly forward, heel coming down on floor and knee bent a little for a left empty stance. At the same time, raise left hand in a curve to nose level, with palm facing rightward and elbow slightly bent while right hand moves to the inside of left elbow, palm facing leftward. Look at forefingers of left hand (Fig 1- 9).

Points to remember: Body position should remain steady and natural, chest relaxed and shoulders and elbows held down. Movement in raising left hand should be more or less circular. In moving right foot half a step forward, place it slowly in position, toes coming down first. Weight transfer must be coordinated with the raising of left hand. Face 9 o¡¯clock in final position.

Form 6. Curve Back Arms on Both Sides

1) Turn torso slightly to the right, moving right hand down in a curve past abdomen and then upward to shoulder level, palm up and arm slightly bent. Turn left palm up and place toes of left foot on floor. Eyes first look to the right as body turns in that direction, and then turn to look at left hand (Fig 1- 10).

2) Bend right arm and draw hand past right ear before pushing it out with palm facing forward while left hand moves to waist side, palm up. At the same time, raise left foot slightly and take curved step backward, placing down toes first and then the whole foot slowly on floor with toes turned outward. Turn body slightly to the left and shift weight onto left leg for a right empty stance with right foot pivoting on toes until it points directly ahead. Look at right hand.

3) Repeat movements in 1~2), reverse ¡°right¡± and ¡°left¡± (Fig 1-10~11).

4) Repeat movements in 1~2) and 3).

Points to remember: Hands should move in curves when they are being pushed out or drawn back. While pushing out hands, keep waist and hips relaxed. The turning of waist should be coordinated with hand movements. When stepping back, place toes down first and then slowly set the whole foot on floor. Simultaneously with body turn, point front foot directly ahead, pivoting on toes. When stepping back, the foot should move a bit sideways so that there will be a transverse distance between heels. First look in the direction of body turn and then turn to look at the hand in front. Face 9 o¡¯clock in final position.

Form 7. Grasp the Bird's Tall-Left Style

1) Turn torso slightly to the right (11-12 o¡¯clock), carrying right hand sideways up to shoulder level, palm up, while left palm is turned downward. Look at left hand.

2) Turn body slightly to the right (12 o¡¯clock) and make a hold-ball gesture in front of right part of chest, right hand on top. At the same time, shift weight onto right leg and draw left foot to the side of right foot, toes on floor. Look at right hand (Fig 1-12).

3) Turn body slightly to the left, taking a step forward with left foot towards 9 o¡¯clock for a left bow stance. Meanwhile, push out left forearm and back of hand up to shoulder level as if to fend off a blow, while right hand drops slowly to the side of right hip, palm down. Look at left forearm (Fig 1- 13).

Points to remember: Keep both arms rounded while pushing out one of them. The separation of hands, turning of waist and bending of leg should be coordinated.

4) Turn torso slightly to the left (9 o¡¯clock) while extending left hand forward, palm down. Bring up right hand until it is below left forearm, palm up. Then turn torso slightly to the right while pulling both hands down in a curve past abdomen- as if you were taking hold of an imaginary foe¡¯s elbow and wrist in order to pull back his body-until right hand is extended sideways at shoulder level, palm up and left forearm lies across chest, palm turned inward. At the same time, shift weight onto right leg. Look at right hand (Fig 1- 13).

Points to remember: While pulling down hands, do not lean forward or protrude buttocks. Arms should follow the turning of waist and move in a circular path.

5) Turn torso slightly to the left as you bend right arm and place right hand inside left wrist; turn torso further to 9 o¡¯clock as you press both hands slowly forward, palms facing each other and keeping a distance of about 5 cm between them and left arm remaining rounded. Meanwhile, shift weight slowly onto left leg for a left bow stance. Look at left wrist.

Points to remember: Keep torso erect when pressing hands forward. The movement of hands must be coordinated with the turning of waist and bending of front leg.

6) Turn both palms downward as right hand passes over left wrist and moves forward and then to the right until it is on the same level with left hand. Separate hands shoulder-width apart and draw them back to the front of abdomen, palms facing obliquely downward. At the same time, sit back and shift weight onto right leg which is slightly bent, raising toes of left foot. Look straight ahead (Fig 1-14).

7). Transfer weight slowly onto left leg while pushing palms in an upward-forward curve until wrists are shoulder high. At the same time, bend left leg for a left bow stance. Look straight ahead. Face 9 o¡¯clock in final position (Fig 1-15). Form 8. Grasp the Bird¡¯s Tall-Right Style Repeat movements 1-7), reversing ¡°left¡± and ¡°right¡± (Fig 1-12~15).

Form 9. Single Whip

1) Sit back and shift weight gradually onto left leg, turning toes of right foot inward. Meanwhile, turn body to the left (11 o¡¯clock), carrying both hands leftward, and left hand on top, until left arm is extended sideways at shoulder level, palm facing outward, and right hand is in front of left ribs, palm facing obliquely inward. Look at left hand.

2) Turn body to the right (1 o¡¯clock), shifting weight gradually onto right leg and drawing left foot to the side of right foot, toes on floor. At the same time, move right hand up to the right until arm is at shoulder level. With right palm now turned outward, bunch fingertips and turn them downward from wrist for a ¡°hook hand¡±, while left hand moves in a curve past abdomen up to the front of right shoulder, palm facing inward. Look at left hand (Fig 1-16).

3) Turn body to the left (10 o¡¯clock) while left foot takes a step towards 8-9 o¡¯clock for a left bow stance. While shifting weight onto left leg, turn left palm slowly outward as you push it forward with fingertips at eye level and elbow slightly bent. Look at left hand (Fig 1-17).

Points to remember: Keep torso erect, waist relaxed and shoulders lowered. Left palm is turned outward slowly, not abruptly, as hand pushes forward. All transitional movements must be well coordinated. Face 9 o¡¯clock in final position, with right elbow slightly bent downward and left elbow directly above knee.

Form 10. Wave Hands like Clouds - Left Style

1) Shift weight onto right leg and turn body gradually to the right (1-2 o¡¯clock), turning toes of left foot inward. At the same time, move left hand in a curve past abdomen to the front of right shoulder, palm turned obliquely inward, while right hand is opened, palm facing outward. Look at left hand (Fig 1-18).

2) Turn torso gradually to the left (10-11 o¡¯clock), shifting weight onto left leg. At the same time, move left hand in a curve past faces with palm turned slowly leftward, while right hand moves in a curve past abdomen up to the front of left shoulder with palm slowly turning obliquely inward. As right hand moves upward bring right foot to the side of left foot so that they are parallel and 10-20 cm apart. Look at right hand (Fig 1-19~20).

3) Repeat movements in 1) and 2) (Fig 1-18~20), reversing ¡°left¡± and ¡°right¡±.

4) Repeat movements in 1-2) and 3) two times.

Points to remember: Use your lumbar spine as the axis for body turns. Keep waist and hips relaxed. Do not let your body rise and fall abruptly. Arm movements should be natural and circular and follow waist movements. Pace must be slow and even. Maintain a good balance when moving lower limbs. Eyes should follow the hand that is moving past face. Body in final position faces 10-11 o¡¯clock.

Form 11. Single Whip

1) Turn torso to the right (1 o¡¯clock), moving right hand to right side for a hook hand while left hand moves in a curve past abdomen to the front of right shoulder with palm turned inward. Shift weight onto right leg, toes of left foot on floor. Look at left hand (Fig 1-21~22).

2) Repeat movements in 3) under Form 9 (Fig 1-16~17).

Points to remember: The same as those for Form 9.

Form 12. High Pat on Horse

1) Draw right foot half a step forward and shift weight gradually onto right leg. Open right hand and turn up both palms, elbows slightly bent, while body turns slightly to the right (10-11 o¡¯clock), and raising left heel gradually for a left empty stance. Look at left hand.

2) Turn body slightly to the left (9 o¡¯clock), pushing right palm forward past right ear, fingertips at eye level, while left hand moves to the front of left hip, palm up. At the same time, move left foot a bit forward, toes on floor. Look at right hand (Fig 1-23).

Points to remember: Keep torso erect, shoulders lowered and right elbow slightly downward. Face 9 o¡¯clock in final position.

Form 13. Kick with Right Heel

1) Turn torso slightly to the right (10 o'clock) and move left hand, palm up, to cross right hand at wrist as you pull left foot a bit backward, toes on floor. Then separate hands, moving both in a downward curve with palms turned obliquely downward. Meanwhile, raise left foot to take a step towards 8 o¡¯clock for a left bow stance, toes turned slightly outward. Look straight ahead.

2) Continue to move hands in a downward-inward-upward curve until wrists cross in front of chest, with right hand in front and both palms turned inward. At the same time, draw right foot to the side of left foot, toes on floor. Look forward to the right.

3) Separate hands, turning torso slightly to 8 o¡¯clock and extending both arms sideways at shoulder level with elbows slightly bent and palms turned outward. At the same time, raise right knee and thrust foot gradually towards 10 o¡¯clock. Look at right hand (Fig 1-24~25).

Points to remember: Keep your balance. Wrists are at shoulder level when hands are separated. When kicking right foot, left leg is slightly bent and the kicking force should be focused on heel, with ankle dorsiflexed. The separation of hands should be coordinated with the kick. Right arm is parallel with right leg. Face 9 o¡¯clock in final position.

Form 14. Strike Opponent's Ears with Both Fists

1) Pull back right foot and keep thigh level. Move left hand in a curve to the side of right hand in front of chest, both palms turned inward. Bring both hands to either side of right knee, palm up. Look straight ahead (Fig 1-26).

2) Set right foot slowly on floor towards 10 o'clock, shifting weight onto right leg for a right bow stance. At the same time, lower hands to both sides and gradually clench fists; then move them backward with an inward rotation of arms before moving them upward and forward for a pincer movement that ends at eye level with fists about 10-20cm apart, knuckles pointing upward to the back. Look at right fist (Fig 1-27~28).

Points to remember: Hold head and neck erect. Keep waist and hips relaxed and fists loosely clenched. Keep shoulders and elbows lowered and arms rounded. Face 10 o'clock in final position.

Form 15. Turn and Kick with Left Heel

Repeat movements on Form 13, but reversing ¡°right¡± and ¡°left¡±.

Form 16. Push Down and Stand on One Leg - Left Style

1) Pull back left foot and keep thigh level. Turn torso to the right (7 o'clock). Hook right hand as you turn up left palm and move it in a curve past face to the front of right shoulder, turning it inward in the process. Look at right hand (Fig 1-29).

2) Turn torso to the left (4 o'clock), and crouch down slowly on right leg, stretching left leg sideways towards 2-3 o'clock. Move left hand down and to the left along the inner side of left leg, turning palm outward. Look at left hand (Fig 1-30-31).

Points to remember: When crouching down, turn toes of right foot slightly outward and straighten left leg with toes turned slightly inward, both soles flat on floor. Keep toes of left foot in line with right heel. Do not lean torso too much forward.

3) Turn toes of left foot outward and those of right foot inward; straighten right leg and bend left leg onto which weight is shifted. Turn torso slightly to the left (3 o'clock) as you rise up slowly in a forward movement. At the same time, move left arm continuously to the front, palm facing right, while right hand drops behind the back, still in the form of a hook, with bunched fingertips pointing backward. Look at left hand (Fig 1-32).

4) Raise right knee slowly as right hand opens into palm and swings to the front past outside of right leg, elbow bent just above right knee, fingers pointing up and palm facing left. Move left hand down to the side of left hip, palm down. Look at right hand (Fig 1-33).

Points to remember: Keep torso upright. Bend the supporting leg slightly. Toes of the raised leg should point naturally downward. Face 3 o'clock in final position.

Form 17. Push Down and Stand on One Leg - Right Style

Repeat Form 16 movements, but reversing ¡°left¡± and ¡°right¡±.

Form 18. Work at Shuttles on Both Sides

1) Turn body to the left (1 o'clock) as you set left foot on floor in front of right foot, toes turned outward. With right heel slightly raised, bend both knees for a half ¡°cross-legged seat¡±. At the same time, make a hold-ball gesture in front of left part of chest, left hand on top. Then move right foot to the side of the foot, toes on floor. Look at left forearm (Fig 1-34).

2) Turn body to the right as right foot takes a step forward to the right for a right bow stance. At the same time, move right hand up to the front of right temple, palm turned obliquely upward, while left palm moves in a small leftward-downward curve before pushing it out forward and upward to nose level. Look at left hand (Fig 1-35)

3) Repeat 1-2), reversing ¡°right¡± and ¡°left¡±.

Points to remember: Do not lean forward when pushing hands forward, nor raise shoulders when moving hands upward. Movements of hands should be coordinated with those of waist and legs. Keep a transverse distance of about 30cm between heels in bow stance. Face 2 o'clock in final position.

Form 19. Needle at Sea Bottom

Draw right foot half a step forward, shift weight onto right leg and move left foot a bit forward, toes on floor for a left empty stance. At the same time, with body turning slightly to the right (4 o'clock) and then to the left (3 o'clock), move right hand down in front of body, up to the side of right ear and then obliquely downward in front of body, palm facing left and fingers pointing obliquely downward, while left hand moves in a forward-downward curve to the side of left hip, palm down. Look at floor ahead (Fig 1-36).

Points to remember: Do not lean too much forward. Keep head erect and buttocks in. Left leg is slightly bent. Face 3 o'clock in the final position.

Form 20. Flash Arm

Turn body slightly to the right (4 o'clock) and take a step forward with left foot for a left bow stance. At the same time, raise right hand with elbow bent to stop above and in front of right temple, palm turned obliquely upward with thumb pointing down, while left palm moves a bit upward and then pushes forward at nose level. Look at left hand (Fig 1-37).

Points to remember: Keep torso erect and waist and hips relaxed. Do not straighten arm when you push left palm forward. The movement should be synchronized with the taking of bow stance, with your back muscles stretched. Keep a transverse distance of less than 10 cm between heels. Face 3 o'clock in final position.

Form 21. Turn to Deflect Downward, Parry and Punch

1) Sit back and shift weight onto right leg. Turn body to the right (6 o'clock), with toes of left foot turned inward. Then shift weight again onto left leg. Simultaneously with body turn, move right hand in a rightward-downward curve and, with fingers clenched into fist, past abdomen to the side of left ribs with palm turned down, while left hand moves up to the front of forehead, with palm turned obliquely upward. Look straight ahead (Fig 1-38).

2) Turn body to the right (8 o'clock), bringing right fist up and then forward and downward for a backhand punch, while left hand lowers to the side of left hip with palm turned down. At the same time, right foot draws towards left foot and, without stopping or touching floor, takes a step forward, toes turned outward. Look at right fist (Fig 1-39).

3) Shift weight onto right leg and take a step forward with left foot. At the same time, parry with left hand by moving it sideways and up to the front, palm turned slightly downward, while right fist withdraws to the side of right hip with forearm rotating internally and then externally, so that the fist is turned down and then up again. Look at left hand (Fig 1-40).

4) Bend left leg for a left bow stance as you strike out right fist forward at chest level, turning palm leftward, while left hand withdraws to the side of right forearm. Look at right fist (Fig 1-41).

Points to remember: Clench right fist loosely. Follow the punch with right shoulder by extending it a bit forward. Keep shoulders and elbows lowered and right arm slightly bent. Face 9 o'clock in the final position.

Form 22. Apparent close-up

1) Move left hand forward from under right wrist and open right fist. Separate hands and pull them back slowly, palms up, as you sit back with toes of left foot raised and weight shifted onto right leg. Look straight ahead.

2) Turn palms down in front of chest as you pull both hands back to the front of abdomen and then push them forward and upward until wrists are at shoulder level, palms facing forward. At the same time, bend left leg for a left bow stance. Look straight ahead (Fig 1-42).

Points to remember: Do not lean backward or protrude buttocks when sitting back. Do not pull arms back straight. Relax your shoulders and turn elbows a bit outward. Hands should be no farther than shoulder-width apart when you push them forward. Face 9 o'clock in the final position.

Form 23. Cross Hands

1) Bend right knee, sit back and shift weight onto right leg, which is bent at knee. Turn body to the right (1 o'clock) with toes of left foot turned inward. Following body turn move both hands sideways in a horizontal curve at shoulder level, palms facing forward and elbows slightly bent. Meanwhile, turn toes of right foot slightly outward and shift weight onto right leg. Look at right hand (Fig 1-43).

2) Shift weight slowly onto left leg with toes of right foot turned inward. Then bring right foot towards left foot so that they are parallel to each other and shoulder-width apart; straighten legs gradually. At the same time, move both hands down in a vertical curve to cross them at wrist first in front of abdomen and then in front of chest, left hand nearer to body and both palms facing inward. Look straight ahead (Fig 1-44-45).

Points to remember: Do not lean forward when separating or crossing hands. When taking the parallel stance, keep body and head erect with chin tucked slightly inward. Keep arms rounded in a comfortable position, with shoulders and elbows held down. Face 12 o'clock in the final position.

Form 24. Closing Form

Turn palms forward and downward while lowering both hands gradually to the side of hips. Look straight ahead (Fig 1- 46).

Points to remember: Keep whole body relaxed and draw a deep breath (exhalation to be somewhat prolonged) when you lower hands. Bring left foot close to right foot after your breath is even. Walk about for complete recovery.

¡¡

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.

For example:

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.

1. After practicing for a while and becoming familiar with the routine of physical movements, you should slow down the movements gradually. For instance the ¡°Simplified Taiji (24 forms)¡±8 usually needs only five minutes, but now you are required to play it for half hour or even longer. Only in this way could you have time to adjust your breath and put the ¡°Xin Fa¡± in it to train your mind. It looks very simple but not easy, and needs time and efforts to practice and train.

2. Read some books about Chinese culture and philosophy, especially Traditional Chinese Medicine, which will help you to understand the essence of Taiji ¡°Xin Fa¡± and your self greatly.

3. According to individual situation, you may select one or more postures as the still style training or meditation as well as the regular Taiji practice.

4. The last one but not the least one is: to cultivate your high moral standard of being responsible for the society, and loving people and life. Only in this way, could you keep your mind peaceful and insist on it for a life time to improve your practice gradually and obtain benefits continuously.

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.

Psychological benefits

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.

SUMMERY

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.

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