May 19, 2009 11:6 WSPC WS-AJCM SPI-J000 00696

The American Journal of Chinese Medicine, Vol. 37, No. 3, 439457

2009 World Scientific Publishing Company
Institute for Advanced Research in Asian Science and Medicine

An Analytical Review of the Chinese

Literature on Qigong Therapy for
Diabetes Mellitus

Kevin W. Chen
Center for Integrative Medicine, University of Maryland School of Medicine
Baltimore, Maryland, USA

Tianjun Liu and Haibo Zhang

Laboratory of Qigong Research
Beijing University of Chinese Medicine, Beijing, China

Zhongpeng Lin
Chinese Academy of Qigong Training, Beijing, China

Abstract: Diabetes rates have doubled in China over the past decade. However, as conven-
tional medicine offers neither a sound explanation nor an effective cure, patients with diabetes
increasingly seek complementary and alternative therapies. It was reported that the traditional
Chinese medical approach, Qigong, might produce therapeutic benefits with minimal side-
effects in this condition. The Qigong Database, the China National Knowledge Infrastructure,
and the library databases of Chinese institutions from 1978 to middle of 2008 on open tri-
als, laboratory studies, and controlled clinical studies were reviewed. Over 35 studies were
identified and reviewed. Qigong therapy for diabetic patients included self-practice, group
qi-field therapy, external qi therapy, and Qigong in combination with other therapies. Only
2 randomized controlled trials were found; both evaluate Qigong as an adjuvant to conven-
tional therapy. All studies reported some therapeutic effect or improvement. Some reported
significant reduction in fasting plasma glucose. Others reported complete cures, which were
unlikely to be the result of placebo effect as objective outcome measures were used. Qigong
therapy may be an important complement to conventional medicine in treating diabetes, but
the quality of studies needs to be improved. These preliminary data are promising and support
the need for further randomized controlled trials.

Keywords: Qigong; Biofield; Diabetes Mellitus; Meditation; External Qi Therapy; Chinese

Medicine.

Correspondence to: Dr. Kevin W. Chen, Center for Integrative Medicine, University of Maryland School
of Medicine, 2200 Kernan Drive, The Mansion, Baltimore, MD 21207, USA. Tel: (+1) 410-448-6876.
E-mail: kchen@compmed.umm.edu

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440 K.W. CHEN et al.

Introduction

The prevalence of diabetes mellitus (DM) is increasing dramatically in China. According to

official estimates, in 1995 about 2.5% of the population aged 25 and older was diabetic. By
2007, this prevalence reached 5%, having doubled in 12 years to an estimated 20 million
patients (China Ministry of Health, 2007).
Scientists have long been searching for effective therapies to treat DM and related symp-
toms. Unfortunately, conventional medicine is not thoroughly clear about the cause and
pathogenesis of this condition and therefore cannot offer an effective cure. DM is gener-
ally regarded to be associated with hereditary, immunological, and environmental factors.
Since 1990, the standard medical model has been transformed from a disease model to a
bio-psycho-social- medical model with 5 key treatment recommendations: dietary control,
physical exercise, blood glucose monitoring, medication, and education. However, a precise
therapy has not been found, and the therapeutic model consists of general remedies to con-
trol the condition without treating the cause. Patients are usually told that DM is a life-long
disorder that cannot be completely cured.
Recent reports in the Chinese literature give a different view on DM treatment, espe-
cially the treatment involving Qigong therapy. Traditional Chinese medicine (TCM) catego-
rizes DM as Xiao Ke ( , wasting-thirst). According to the holistic TCM perspective,
DM is the result of multiple factors that include irregular diet, over-intake of sweet and
fatty foods, immoderate sex and alcohol, and excessive physical or mental stimulation. Its
pathogenesis is considered to be the accumulation of Heat (Yang) and the consumption
of Yin, where the Lung, Spleen and Kidney are all directly affected. Treatment focuses
on giving comprehensive, individual, and integrated recommendations for the whole body
(Liu and Feng, 2005) and varies according to TCM differentiation into syndromes. These
are based on the particular symptoms that accompany the Xiao and include external
therapies (acupuncture and herbs) combined with psychotherapy and self care, especially
Qigong.
Qigong refers to psychosomatic maneuvering techniques or skills that integrate breathing,
mind, and body posture into oneness (Liu and Hua, 2005). It has long been a TCM treatment
modality and plays an important role in the preservation of health.
TCM assumes that good health is the result of a free-flowing, well-balanced qi (bioen-
ergy) system, while sickness and pain are the result of qi blockage or imbalance. From this
perspective, most DM is considered to be the result of unbalanced internal subsystems, or
blockage of the channels in the body through which qi naturally flows. Different imbalances
or blockages are held to produce different syndromes, or types of diabetes: (1) Upper-Xiao:
excessive fire in the Lung, which burns and damages the Lungs Yin aspect. Its symptoms
are thirst, frequent urination, and irritation or a negative mood. (2) Middle-Xiao: excessive
fire in the Stomach caused by over- consumption of rich and sweet foods that exhaust the Yin
aspect of the Stomach. Its symptoms are weight loss despite food cravings and the increased
consumption of meat and sweets. (3) Lower-Xiao: weakness in the Kidney, which exhausts
the Yin-jing (essential body fluids), essential energy, and the essential qi. Its symptoms are
waist and leg pains, poor vision, and memory loss (Liu and Hua, 2005).
May 19, 2009 11:6 WSPC WS-AJCM SPI-J000 00696

REVIEW OF QIGONG THERAPY FOR DIABETES 441

As DM is divided into several syndromes in TCM diagnosis, Qigong therapy is aimed

at the specific sources of the disorder. The goal is to balance the relationships among all
the bodys subsystems and the body and its environment by activating and promoting the
individuals self-healing potential. Once the body is returned to normal self-regulation, its
Upright-Qi is restored, and pathogenic factors can no longer affect it. In this way, DM can
be treated, prevented, and even radically cured (Jin, 1996).
The modern study of Qigong treatment for DM began in 1980s. In 1996, China Qigong
Science (the official journal of the Chinese Qigong Society) held a conference on Qigong
therapy for the conditions at which thousands of successful cases were presented, showing
that the therapy offered great possibilities for improving or curing most DM. These reports
are in sharp contrast to the Western medical perspective, which is that DM is a life-long
disorder that cannot be completely cured.
Is Qigong therapy really effective in treating DM? Can DM really be cured by TCM
methods such as Qigong? To what extent do research findings support this claim? What
are the mechanisms by which Qigong acts on DM? This review of the literature in Chinese
provides some preliminary information to answer these questions. Although the quality of
Qigong research in China has been generally low due to lack of resources and experience, the
data generated by these studies may still be useful for investigators and medical practitioners
wishing to know what has been done in China.

Methods

This analytical review is based on two major sources: (1) the Qigong Database assembled by
the Qigong Institute (Sancier, 2001), which consists of more than 4000 abstracts and publi-
cations from various conference proceedings and publications; and (2) a systematic search
of publications listed in various Chinese databases such as the China National Knowledge
Infrastructure (CNKI) and the library databases at major Chinese universities and other insti-
tutions. Most of this literature has never been published in English. A recent review by Liu
et al. (2007) included some studies in Chinese but missed some important ones, especially
controlled studies and laboratory studies. Another recent review (Lee et al., 2008) of Taiji
(or Tai Chi, a movement form of Qigong), identified 5 controlled studies performed between
2003 and 2007, including 2 random controlled trials (RCTs). The authors concluded that
evidence supporting the practice of tai chi for treating Type 2 diabetes is scarce and not
convincing. The value of tai chi for this indication therefore remains unproven.
The present review is a contribution to this area of knowledge, as most of these studies
are unknown to English readers. We used the key words Qigong and diabetes mellitus
(DM) to search all major computerized databases in Chinese libraries from 1978 to 2008.
We found 7 studies from the Chinese Magazine Database, 41 from the Chinese Scientific
and Technological Journal Database, 43 from the China TCM Database, and 21 from the
library of the Chinese Academy of Qigong Training. As many of these are duplicated entries,
in total 35 papers were identified and are briefly reviewed here.
Few of these Chinese studies truly adhere to Western scientific standards regard-
ing research design and reporting format. Some were not for scientific publication.
May 19, 2009 11:6 WSPC WS-AJCM SPI-J000 00696

442 K.W. CHEN et al.

Consequently, incomplete data reporting is a major problem in these studies. If we had

applied the scientific criteria of Western medicine, such as randomization and placebo-
control, to this literature, we would have ended up with few or no reports. Indeed, it may be
impractical to conduct a double- blind placebo-controlled trial of Qigong therapy. However,
these Chinese examples of successful Qigong treatment of DM may help practitioners and
researchers to recognize the potential of this ancient therapy. Additionally, the RCT is not
the only method for documenting a new therapy in a clinical situation. To fully allow the
existing literature to inform future research and health care, we decided to review whatever
we could find but focus on those studies with sound design, statistical analysis, or good
theoretical assumptions. Of the studies without statistical analyses, we report those with a
reasonable sample size (20 or more cases) and objective measures (such as fasting serum
glucose) to give the reader a more complete picture of the state of the field.

Results

DM has been treated clinically with many different forms of Qigong. In the literature we
encountered methods such as self-practice, guided group practice, external qi therapy (EQT),
and Tuina (Qigong massage), many of these were combined with dietary control and the
gradual reduction of medication. So far no study compares the effectiveness of the various
forms.

Self-Practice Qigong for Treating Diabetes

Many documented successes of Qigong therapy for DM are case reports with no control
group. Half of the studies we reviewed fall in this category. Typically, an observational study
involves baseline screening to qualify patients, teaching the patient to practice Qigong on
a daily basis for a period of time (from 2 weeks to 2 years), and conducting 1 or more
follow-up physical exams to determine therapeutic effect. The exam may include a fasting
serum glucose test, urine glucose test, and other standard Chinese measurements for DM.
Most studies report a certain percentage of effectiveness, but their criteria were not nec-
essarily comparable with those of other studies. Although such observational studies may
have little scientific validity or reliability, successful case reports provoke more systematic
scientific studies and clinical trials. Table 1 summarizes the major findings of 17 studies
of the therapeutic effects of Qigong self-practice on DM, one of which had a randomized
control group for comparison. We will briefly report a few of these below.
In a typical observational study, Ji and Zhou (1994) reported the therapeutic effect of
Wudang Zhonghe Qigong in treating 183 diabetic patients. After baseline assessment, follow-
up assessments occurred on day 7 and after 1 month and 3 months of Qigong practice.
Reported recovery rates were 27%, 56% and 85%, respectively, to normal fasting serum
glucose, and 22.9%, 46.5% and 80%, respectively, to the urine glucose test. The symptoms
of 95% of the patients were completely alleviated after three months of intensive Qigong
practice.
 Table 1. Summary of Studies on Qigong Therapy Alone as DM Treatment

Author Qigong and Ns Research Outcome Results/Major Findings Conclusion/Note

(Year) Features Design Measures
May 19, 2009 11:6 WSPC

Shen et al. Hexiang Zhuang 20 SC, tolerance of FSG, SG 30 min, FSG was reduced significantly (p < 0.01), as was
(1987) Qong daily oral glucose (75 g) SG 1 hour, SG SG 30 min and SG 2 hours (p < 0.05). But NS of
(standing form) with Qg 2 hours, SG other indicators. TCH & TG were decreased.
3 hours, TCH, TG
Wu et al. Zhengqi Yunxing 28 SC, type II DM, 1 FSG, SG 2 hours FSG and SG 2 hours reduced significantly after
(1991) Fa daily for 1 and 6 months 1 month of Qg, 11 Ss followed 6 months later
month follow-ups with stable effects.
Li and Liu Inner-nourishing 20 SC, Qg+ Chinese criteria 2 cured, 17 significantly improved and 1 no Qigong benefits DM
(1993) Qigong restricted diet and for diagnosis of effect. Effective rate 95%. Significantly reduced patients.
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4060 min, exercise DM med; no insulin needed at the end.

3/day for 3
months
Jing et al. Huichun Qigong 31 SC, type II DM FSG, TCH, TG, FSG, TCH, TG all were significantly reduced (p
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(1994) daily for 1 year IRI, APOH1, < 0.01) after 1 year of qigong, plus improved
APOB micro-circulation index.
Zhang et al. Zang Mi Qigong 42 SC FSG, UG pre- and Significant FSG reduction (p < 0.01), and UG (p
(1994) lecture and post-Qg in 42 Ss < 0.01) was reported after Qg practice in all 6
practice for 10 follow-up measurements.
days
Ji and Zhou Wudang Zhong 183 SC, 7-day, 30-day FSG, UG a % of FSG was reduced to normal at 7, 30 and 90
REVIEW OF QIGONG THERAPY FOR DIABETES

(1994) He Gong daily and 3-month days: 27.1%, 55.8% and 85.0%; % UG negative:
follow-up 22.9%, 46.5% and 80%; 95% reported improved
DM symptoms.
Piao et al. Zhineng Gong in 65 SC, measured FSG, TG, TCH & FSG reduced from 12.2 to 9.2 mmol/l, 26% in The change was not
(1995) group qi field pre-, during and cardiovascular normal range. TG reduced from 2.26 to 0.76 linear, but up and
daily post-Qigong indexes mmol/l, in normal range. Significant down in many cases.
practice improvement in cardiovascular function.
443
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Table 1. (Continued)

Author Qigong and Ns Research Outcome Results/Major Findings Conclusion/Note

(Year) Features Design Measures
May 19, 2009 11:6 WSPC

Li (1995) Inner-nourishing 52 SC, Taiji quan FSG, SG 2 hours Complete cure, 16 (31%) Ss, significant
Qigong daily for 2 plus controlled and UG improvement, 54%, and some improvement,
years or more diet 15%. Totaleffectiverate = 100%. Significant
symptom improvement reported.
Zhou and Ji Wudang Zhong 48 SC, type II DM; FSG, UG a 48 Ss on Day 7: FPG reduced in 38 and normal
(1995) He Gong daily for 7- to 30-day in 13; UG normal in 11, reduced in 26; 43 cases
7 or 30 days follow-ups on Day 30: FPG reduced in 41 and normal in 24;
UG reduced in 30 and normal in 20.
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Qian and Neidan or 50 SC, type II DM FSG, TCH, TG, & Significant reductions in FSG (p < 0.001), TCH
Zhang (1997) Zhineng Qigong WHO diagnosis (p < 0.05), and TG (p < 0.01) were reported
criteria after Qg; 91.4% reported significant
00696

improvement in DM symptoms.
Zhang (1997) Zhineng Gong 32 SC, type II DM Chinese criteria 7 cured, 13 significant improved, 10 some No time period
K.W. CHEN et al.

for diagnosis of improvement, 100% effective. specified.

DM
Feng et al. Daily Qigong 60 RCT, Control (30) FSG, SG 2 hours, Qigong group had a significantly greater One of the few
(1998) practice med only. Qg (30), TCH, TG and UG decrease in FSG (
3.63 vs.
2.15; p < 0.01). randomized
mostly type II DM Plasma insulin levels were significantly higher controlled studies.
from Qigong than in control after treatment
(19.7 vs. 15.3; p < 0.01).
Wang and Taiji exercise 20 SC FSG, TG, TC, Taiji exercise reduced FSG and TG significantly
Huang (1998) daily for 8 weeks Hyperlipidemia serum insulin (p < 0.05). Long-term Taiji improved serum
with type-2 DM lipid and glucose metabolism by decreasing
insulin resistance.
 May 19, 2009 11:6 WSPC

Table 1. (Continued)

Author Qigong and Ns Research Outcome Results/Major Findings Conclusion/Note

(Year) Features Design Measures

Cheng et al. Miaofa Yuanrong 29 SC FSG and other FSG reduced from 11.3 to 8.1 mmol/l after 30
(1999) Gong daily for 30 WHO criteria days Qigong (p < 0.01); 29% normal & 17% at
days or more satisfying levels. Significant improvement in
DM symptoms reported.
Yang and Zhineng Qigong 56 SC, type II DM FSG and Chinese 12 cured (FSG normal), 26 significantly
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Yang (1999) clinical criteria improved, 8 no change, total effective rate

86.7%.
Zhang et al. Zang Mi qigong 42 SC FSG, UG pre- and Significant reductions in FSG (p < 0.01) and Long-term effect for
00696

(1999) daily for 4 years post-Qi in 42 Ss UG (p < 0.01) were reported after Qigong 4 years.
practice in all 6 follow-up exams.
Yang et al. Inner-nourishing 37 SC in-patient FSG, UG at 28 (76%) patients reported significant Qigong may be
(2006) Qigong treatment: group baseline and improvement in FSG and quality of life. Of 19 more effective for
Qigong practice monthly mild DM (FSG 11.1 mmol/l), 17 (89%) mild to moderate
twice a day for 3 reduced FSG below 6.1; of 12 moderate DM, 9 DM, which
months (75%) reduced FSG below 7.8; of 6 heavy DM encourages early
(FSG > 16), 2 (33%) reduced FSG below 11.1. treatment.
REVIEW OF QIGONG THERAPY FOR DIABETES

Abbreviations: FSG = fasting serum glucose, or fasting blood sugar; SG 30 min = serum glucose 30 min after meal; SG 2 hours = serum glucose 2 hours after meal; UG
= urine glucose; HDL = high density lipoprotein; TG = triglycerides; TCH = total cholesterol; IRI = insulin resistance index; ISI = insulin sensitivity index; Qg =
Qigong; Ss = subjects; NS = not significant; RCT = randomized controlled trial; SC = self control (no control group).
445
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446 K.W. CHEN et al.

Jing et al. (1994) reported the effects of Huichungong Qigong practice in 31 patients with
type II diabetes. The results showed that patients fasting plasma glucose (FPG), cholesterol
and triglycerides were reduced significantly (p < 0.001). Huichungong was also found to
affect fasting blood insulin, as the fasting blood insulin indexes of 22 patients returned
to normal. Nail fold microcirculation was also improved. High density lipoprotein (HDL)
increased in 7 patients (p < 0.05), and apolipoprotein (APOH1 , APOB and the ratio of both;
the former p > 0.05; the 2 latter p < 0.001) decreased in 13 patients. Fluorescent polarizing
of the lipid layer of red cell membranes and microviscosity were reduced in 10 patients (p
< 0.001). The researchers stated that both the amoeboid activities of red blood cells and
microcirculation were improved.
The form of Qigong most frequently used in treating DM is Neiyang Gong, Inner-
Nourishing Qigong, a medical Qigong form recommended by the Chinese government. Yang
et al. (2006) reported outcomes for 37 diabetes patients who received in-patient treatment
with Neiyang Gong in their Qigong Hospital. The patients were classified by FSG into 3
categories according to the severity of their DM: 19 in mild DM (FSG 11.1 mmol/l), 12 in
moderate, and 6 in severe (FSG >16 mmol/l). The treatment included group Qigong practice
twice a day for 3 months. The primary outcome was FSG after 3 months with the indicator
of effectiveness defined as FSG below 6.1 for the mild group (17 of 19 patients achieved
this), below 7.8 mmol/l for the moderate group (9 of the 12 accomplished this), and below
11.1 mmol/l for the severe group (2 of the 6 attained this). The overall effective rate was
76%, with mild DM patients reporting better results than those of the severely affected.
Two studies reported the results of longitudinal follow-up. Li (1995) reported on 52
patients treated with Neiyang Gong between 1981 and 1993. After follow-up of 2 years or
longer, 16 were completely cured according to the 1984 standards of the Chinese government,
28 showed significant improvements, and 8 reported some improvement. In addition to
Qigong, patients engaged in moderate physical exercise plus some dietary control. These
patients also reported significant reduction or complete disappearance of other related health
problems after Qigong practice. Zhang et al. (1999) followed a group of diabetics treated by
Qigong for 4 years. They assayed the levels of serum and urine glucose 7 times (6 times after
Qigong practice), and reported that all follow-up measurements were significantly decreased
(p < 0.01) in comparison to the ones before practice. Five times after Qigong practice, the
urine glucose indexes showed highly significant decreases in comparison to them before the
practice. These results suggest that practicing Qigong for 2 hours a day may relieve diabetic
symptoms and signs. Zhang et al. (1999) also reported that ECG results showed that Qigong
may reduce the occurrence and frequency of diabetic cardiovascular diseases, which are
common complications of DM. The study suggests that ongoing Qigong practice is the key
to maintaining long-term effects.

Self-Practice plus External Qi Therapy

Some studies report a combination of self-practice Qigong and EQT for treating DM. EQT is
part of the medical Qigong tradition and refers to the process by which Qigong healers direct
or emit their qi energy to help the patients to break qi blockage and remove unhealthy qi. This
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REVIEW OF QIGONG THERAPY FOR DIABETES 447

technique balances the qi system, which in turn relieves pain and eliminates disease. Although
the physical nature of qi remains unknown and is under debate in the scientific community,
EQT has long been used by Chinese medical practitioners, and there are intriguing reports
that suggest the possibility that physical, biophysical and/or biochemical alterations are
induced by qi-emission (Chen, 2004). Table 2 summarizes the results of 5 such studies.
The Huaxia Training Center for Zhineng Qigong (1992) reported on the therapeutic
effects of Zhineng Qigong group practice, assisted by Qigong healers, on 425 diabetic
patients. After 22 to 44 days of group Qigong treatment and self-practice in the group qi
field organized by the Qigong master, 144 were symptom free and FBS was normal, (34.5%);
123 were markedly improved (28.9%); 128 had some noticeable symptom reduction (30.1%),
and only 27 (6.4%) showed no effects at all. The total effective rate was 93.6%.
A 1994 study at the same center measured the therapeutic effect of group Qigong prac-
tice on 120 DM patients. The outcome was evaluated by comparing pre- and post-Qigong
practice FPG levels. Some type I patients in this study tried to reduce their drug intakes.
After one to two months of group Qigong practice, FPG levels were significantly decreased
(p < 0.01). Of the 10 type I diabetic patients, 1 reported a complete cure and nine reported
significant improvement. Of the 110 type II diabetic patients, 13 were clinically cured,
31 were markedly improved, and 55 had noticeable symptom reduction. Only 1 patient
showed no effects. The study also reported ECG improvement and decrease in blood lipids.
The authors stressed that the key factor in treating DM with Zhineng Qigong is regulation of
the mind. In addition to Qigong, exercise, dietary control, and gradual reduction of dosages
or withdrawal from drugs in accordance with the patients condition were also important
aspects of the treatment.

Combining Qigong Therapy with Other TCM Therapies

Qigong therapies have been used with other TCM therapies, either as a supplement or the
major treatment, to maximize therapeutic effects. These include acupuncture, acupressure,
herbal medicine, and Tuina. Table 3 summarizes the results of 6 studies of Qigong therapy
plus other TCM treatments.
Sun and Shan (1995) treated 25 diabetics with Qigong plus acupressure. After 2 courses
of treatment, the FSG and UG indexes of most patients returned to normal, clinical symptoms
were greatly relieved, good short-term effects were notable, and the clinical effective rate
reached 96%. At the half-year follow-up, the long-term effective rate was 79%, as some
patients suffered relapses. The relapses may have occurred in part because the patients
failed to follow the doctors advice, but a few who did comply with the advice still suffered
relapse. The researchers concluded that this combination needs further study.
Yu et al. (1989) treated 48 diabetic patients, all of whom met WHO criteria for DM, with
Tuina plus self-practice Qigong. The actual Tuina therapy and the acupoints used varied by
individual, depending upon whether the symptoms were Upper-, Middle- or Lower-Xiao.
Tuina was administered every other day for 40 sessions, and patients practiced Shaolin
Neigong Qigong every morning for 40 min after the first 20 treatments. All patients reported
significant reduction of glucose in blood and urine. Applying the conventional Chinese
 448
Table 2. Summary of Studies on Qigong Practice Plus External Qi Therapy as DM Treatment
May 19, 2009 11:6 WSPC

Author Qigong and Ns Research Outcome Results/Major Findings Conclusion/Note

(Year) Features Design Measures

The First Zhineng Qigong 425 SC, daily Qigong Chinese criteria 34.6% cured, 28.9% significant improvement,
Recovery Unit with group qi field for 22 to 44 days for diagnosis of 30.1% some effective, 6.4% no effect, total
of HuaXia daily DM FSG, UGa effective rate 93.6%.
Zhineng
Qigong
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Training
Center (1992)
The First Zhineng Qigong 120 SC, type I 10, and FSG, cholesterol Type I cases: 1 cured, 9 significant improvement.
Recovery Unit with group qi field type II 110 cases & ECG Type II cases: 13 cured, 31 significantly
00696

of HuaXia daily improved, 55 some improvement, 99% effective.

Zhineng
K.W. CHEN et al.

Training
Center (1994)
Zhu (1996) Zeng Qigong 43 SC Chinese criteria 53% (23) cured or significant recovery, 25% (15)
daily plus EQT for DM diagnosis improved, 11% (5) no effect.
Huang (2000) Qigong daily plus 40 SC Chinese criteria 20 cured or complete recovery, 17 significant
EQT, acupressure for DM diagnosis improvement, 3 no effect, effective rate 92%.

Abbreviation: a FSG = fasting serum glucose, or fasting blood sugar; UG = urine glucose; HDL = high density lipoprotein; ISI = insulin sensitivity index; SC =
self-control (no control group).
 May 19, 2009 11:6 WSPC

Table 3. Summary of Studies on Qigong Therapy Plus Other TCM Therapies as DM Treatment

Author Qigong and Ns Research Outcome Results/Major Findings Conclusion/Note

(Year) Features Design Measures

Zhu (1985) Zhikong Qigong 20 SC, type II DM FSG, UG a 4 cured or significantly

plus EQT and recovered, 14 improved, 2 no
acupoint message effect. Effective rate 90%.
Kuang et al. Qg practice and 93 SC, type II DM, FSG, kidney After Qg & TCM treatment,
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(1989) TCM herbals 18 child-bearing, deficiency index, FSG and kidney deficiency
75 post- Estrodial to index reduced significantly (p
menopausal testosterone ratio < 0.01); E/T ratio increased
significantly.
00696

Yu et al. Shaolin Qigong 48 SC; 30 min/ every WHO criteria for 20 cured, 10 significant Different acupoints
(1989) 40 mins daily + other day for DM diagnosis, recovery, 8 improved, and were used for
Neigong Tuina 40 mins FSG, UG, SG 10 no effect. Total effective different types (the
2 hours rate 79%. Mean FPG & Ug 3 Xiao) of DM.
reduced significantly. Med.
use reduced or stopped for
many patients.
Sun and Shan Qigong acupoint 25 SC, inpatient FSG, UG 96% patients had normal FPG Length of Tx course
REVIEW OF QIGONG THERAPY FOR DIABETES

(1995) massage and treatment daily and UG after 2 courses of not specified.
acupressure treatment.
449
 Table 3. (Continued) 450
Author Qigong and Ns Research Outcome Results/Major Findings Conclusion/Note
May 19, 2009 11:6 WSPC

(Year) Features Design Measures

Tian (1995) Yuzhan Qigong plus 621 SC, most patients Chinese criteria 94.6% cured, 3.3% improved, Length of Tx course
foot acupoint with other chronic DM diagnosis, 0.5% no effect. With some not specified.
massage daily conditions FSG, UG long-term follow-up, patients
stayed healthy.
Yang (1996) Qigong plus 1432 SC, customized Chinese criteria Upper Xiao (n = 578), 100% Different types of
massage, herbs and Tx for diff. types DM diagnosis, cured after 1 course. DM responded to
acupuncture (the 3 Xiao), 45 FSG, UG Mid-Xiao (n = 295), 66% the same Tx
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days per course cured by 2 courses, 29% differently. Lower-

improved, 29% stopped Xiao most difficult
Qigong practice. Lower-Xiao to treat.
00696

(n = 560): 29.2% cured by 2

courses, 6.1% by 4 courses,
K.W. CHEN et al.

56.4% improved.
Yuan et al. Kidney-nourishing 65 RCT medicine in FSG, Fast insulin, Both groups, 84% effective. One of the few
(1999) Qigong vs. control n = 33; SG 2 hours, but, SG 2 hours and HBAIC randomized
medications only, Qigong plus med HBAIC, ISI were reduced more in Qigong controlled studies.
for 3 months n = 32 group than in control (p <
0.01). ISI levels were
significantly higher in Qg
group (p < 0.05) after 3
months.

Abbreviations: FSG = fasting serum glucose, or fasting blood sugar; UG = urine glucose; SG 2 hours = serum glucose 2 hours after meal. RCT =
randomized control trial; SC = 4 self control (no control group).
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REVIEW OF QIGONG THERAPY FOR DIABETES 451

clinical criteria, 20 patients were completely cured, 10 were markedly improved, 8 were
noticeably improved, and 10 showed no improvement. The total effective rate was 79.2%.
Yang (1996) reported comprehensive therapeutic results by combining Daofu Yannian
Gong, massage, acupuncture and herbal medicine on 1,432 diabetic patients. He classified
diabetes according to TCM theory and applied different Qigong techniques and various com-
binations of other therapies to treat the patients. Of the 578 diabetics with the characteristics
of Upper-Xiao, all recovered completely after 45 days of comprehensive Qigong treatment.
Of 294 patients with characteristics of Middle-Xiao, 194 recovered after 90 days of compre-
hensive treatment, 86 showed marked improvement, and 86 withdrew from Qigong practice.
Of 560 patients with characteristics of Lower-Xiao, 164 completely recovered after 90 days
of treatment, 34 recovered after 180 days of treatment, 316 were markedly relieved but not
cured, and 56 had withdrawn.
Yuan et al. (1999) randomly assigned 65 type II diabetics into 2 groups. A control group
(n = 32) received conventional Western and Chinese medications (the best available in the
market), and a Qigong group (n = 33) supplemented these medications with additional
3045 min of Bushen Qigong (Kidney-nourishment) exercise twice a day. After 3 months
of treatment, they found that patients in both groups showed significant improvement in
levels of FPG (p < 0.001) and fasting insulin (p < 0.01). Compared to the control group,
the Qigong group had significantly more reduction in plasma glucose 2 hours after a meal,
greater reduction in glycosylhemoglobin (p < 0.01), and a significant increase in the insulin
sensitivity index (p < 0.05). It was suggested that Bushen Qigong practice might enhance
the sensitivity of insulin. In addition, the total effective rate of both groups exceeded 84%
according to the clinical criteria of the Chinese Department of Health in 1993, although there
was no significant difference in effective rate between the 2 groups.

Animal Studies of Qigong Therapy for Diabetes

One of the major criticisms of Qigong therapy is the possibility of psychological effects or
suggestibility during Qigong practice. To effectively exclude any psychological effects of
the therapy on diabetes treatment and to understand the Qigong effect on DM, scientists have
applied EQT to animal diabetic models. Since animals cannot practice Qigong, the biological
effects of external Qi were initially explored from different perspectives on diabetic rat
models. We found 4 animal studies focused on the therapeutic effects of Qigong therapy
for DM.
Feng et al. (1996) established an animal DM model by injecting 2.5% alloxan
(C4 H2 N2 O4 ) (12 mg/100 g body weight) into Wister rats for 2 days. A week later, these rats
showd the continuous high levels of plasma glucose. Thirty rats were randomly assigned
into 3 groups: normal control, DM control, and DM Qigong treatment. The controls did not
receive treatment. Rats in the Qigong group received EQT for 30 min, 5 times a week, for
a total of 20 sessions. Each week, urine and blood samples were taken to evaluate serum
plasma glucose, urine glucose, and peripheral blood insulin levels. Figure 1 presents the
plasma and urine glucose levels at baseline and weekly follow-ups. One week after alloxan
injection, DM rats had significantly higher levels of plasma and urine glucose (p < 0.01)
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452 K.W. CHEN et al.

(a)

(b)

Figure 1. (a) The effect of Qigong on the level of serum glucose in DM rats over time (mg/dl). (b) The effect of
Qigong on the level of urine glucose in DM rats over time (mg/dl).

than those of normal control. After 4 weeks of Qigong treatment, glucose in plasma and
urine of the Qigong group had returned to the levels close to those of normal control and
were significantly lower than those of DM control (p < 0.01). The study also demonstrated
that external Qi increases peripheral blood insulin levels in a DM rat model.
Fu et al. (1994) conducted a similar EQT animal study to explore the effect of Qigong
on the microcirculation system in rats with DM. They injected alloxan (12 mg/100 g body
weight) into the Wister rats for 5 days until their plasma glucose levels reached 240 mg/dl
or higher. Then the rats were randomly assigned into 2 groups: Qigong and control. The
treatment group was given external Qigong every day, and blood flow in limbs and eyes
were measured continuously during the therapy. The blood volume of the diabetic rats
extremities had a trend toward change from low to high levels, then a return to low levels.
This reflected the developing process of DM. EQT influenced this process by enhancing
the regulating effect of the autonomic activities of the vascular endothelial cells, resulting in
improved microcirculation. A significant reduction of urine glucose (p < 0.01) and relatively
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REVIEW OF QIGONG THERAPY FOR DIABETES 453

stable body weight in Qigong group were observed in comparison to the body weight changes
in the control.
Liu (1997) established a rat diabetic model by injecting streptozotocin until fasting
serum glucose reached a level greater than 11 mmol/l. Thirty Wister rats (20 with diabetic
symptoms) were randomly divided into 3 groups: non-treatment, Qigong therapy, and sham
Qigong. The Qigong group was exposed to a real Qigong field for 2 hours a day for 20 days,
while the sham group was exposed to a laboratory technician instead. The results showed that
the GSH-PX activities of DM rats exposed to the qi field significantly improved, and their
plasma MDA tended to decrease. LPO in liver and kidney tissues were also significantly
lower than that of the control (p < 0.01), as was FSG after 20 days of treatment. These
results were replicated by 3 subsequent studies. The author concluded that the qi field had
a regulating effect, lowered blood glucose, and relieved diabetic symptoms. His hypothesis
was that the qi enhanced cell utilization of glucose to promote the formation of hepatic and
muscle glycogen and increase oxidization and glucose utilization in tissues.

Discussion

Most current treatments for DM effectively control the symptoms to varying degrees, how-
ever, they come with significant drawbacks or side-effects and cannot produce a true cure.
An inexpensive, effective, non-pharmacological therapy for DM with no side-effects could
have a major impact on diabetes treatment, and the data on Qigong therapy is promising. Pre-
liminary studies report immediate improvement of diabetic symptoms with no side-effects,
and complete remission is even recorded in some patients who engage in ongoing Qigong
practice. The therapy involves a bioenergy that is not identified scientifically but has great
potential to become a powerful adjuvant to conventional treatment. However, better-designed
clinical trials that systematically test this therapy in human patients are needed to determine
its efficacy and applicability. A recent qualitative literature review (Liu et al., 2007) reached
a similar conclusion: Although qigong has beneficial effects on some of the metabolic
risk factors for type II diabetes, methodological limitations make it difficult to draw firm
conclusions about the benefits reported.
These studies are preliminary, and most of them need to be replicated by additional
laboratories and clinics in order to verify their reliability. Nonetheless, the extant research
draws a promising picture and suggests that Qigong therapy for diabetes treatment warrants
further study. Unfortunately, this area is often neglected by mainstream medical researchers,
who typically criticize the existing studies of Qigong as premature. As a result, no Western
institution has become seriously involved in this field of research. A deeper understanding of
Qigong may help it to be more widely accepted by researchers and the medical community
at large.

Exploration of the Mechanisms

As multidisciplinary studies of Qigong have increased, the effects and mechanisms of the
therapy on DM have been explored from various perspectives, particularly by Chinese
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454 K.W. CHEN et al.

scientists. For example, Liu et al. (1997) report that Qigong practice increased T3 and T4,
impaired by aging or disease, to normal levels. This increase inhibits excretion of insulin
and relieves the burden of islet cells, gradually restoring them to normal functioning. Jing
et al. (1994) showed that Qigong practice also lowered serum insulin and strengthened the
sensitivity and biological effects of insulin by improving target cell receptor affinity and
enhancing the function of inlet cells to promote the utilization of glucose.
Some researchers speculate that the tranquil state produced by Qigong practice might
bring about a unique inhibition of some activities of the cerebral cortex, inducing the pro-
tection and repair of the brain and the enhancement of its higher nervous activities. They
hypothesize that Qigong may enable the cerebral cortex to restore balance between excite-
ment and inhibition, rectify the dysfunctions of the autonomous nervous system, excite
parasympathetic activity, lower sympathetic activity, and regulate inlet cells. These activ-
ities may lower blood glucose by increasing the excretion and release of insulin (Li, 1995;
Wu et al., 1991; Zen, 1996).
From a psychosomatic perspective, Zhang and Han (1995) believe that Qigong may
heal DM by activating psycho-physiological regulating effects via self-regulation of the
nervous, endocrine, and immune systems. Zhang et al. (1994) state that Qigong may acti-
vate the nervous and endocrine systems by means of sound wave vibrations in head, neck,
and chest. Another suggestion is that vibrations from infrasonic waves modify the blood
and lymphatic circulation to regulate the internal environment, restore homeostasis, and
heal DM.

Problems and Limitations

These studies suggest that Qigong therapy may be a powerful alternative for treating DM,
even though current research geared toward Qigong and its therapeutic effects has many
deficiencies and limitations. Recognizing these is an important step toward in-depth inves-
tigations into Qigong as a therapy for diabetes and other chronic conditions:
(1) At present, lack of sophisticated research design and controls undermines the results of
many of the clinical observations and studies on Qigong.
(2) Lack of support and needed resources lowers their quality. Most of existing studies
have been done by Chinese scientists with little support and few resources. Some were
conducted by Qigong practitioners with no support from health care professionals.
(3) Lack of suitable laboratory investigations of the mechanisms by which Qigong alleviates
DM reduces acceptance of the therapy by medical professionals.
Moreover, Qigong comes in many forms. Not all forms are equally effective in treating dia-
betes, and not all Qigong masters can emit sufficient external qi for scientific study. Without
physical or biological measurements of qi and its effects, and with a research community
that lacks general interest in the Qigong effect, studies comparing the effectiveness of types
of Qigong are unlikely. Many investigations of Qigong therapy for DM even do not specify
what form of Qigong was used or how it differs from others, making reviews and evaluations
even more difficult. It is imperative for practitioners to state what type and format of Qigong
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REVIEW OF QIGONG THERAPY FOR DIABETES 455

they use during treatment and for researchers to explore the various mechanisms of different
kinds of Qigong.

Conclusion

The very existence of human subtle energy has been a challenge for modern medicine and
modern science in general, as we really have had no effective ways to measure and so far
have only simple observations of its activities and therapeutic effects. However, more and
more evidence suggests that Qigong therapy for diabetes is more than just a psychological
effect, and these studies suggest that Qigong may be a powerful alternative to current DM
treatments. Chinese scientists are not alone in demonstrating the therapeutic effects of human
subtle energy in the treatment of DM. Iwai et al. (1999) from Japan report the effect of
Qigong walking on diabetic patients and conclude that it reduced plasma glucose after
lunch without inducing a large increase in the pulse rate. Jain et al. (1993) and Singh et al.
(2004) of India report the therapeutic effects of Yoga, an energy medicine practice similar
to Qigong, on type II diabetic patients. Hopefully more scientists around the world will
follow the lead of these investigators and collaborate in this challenging area. Professor
Qian Xuesen, the honorary chair of the Chinese National Association of Scientists, has
unequivocally advocated the creation of a human body science, parallel to social science
and natural science. Qigong would be a leading discipline of that new science (Qian et al.,
1988). Qian predicts that the integration of TCM, Qigong, special human body functions, and
a unified body of theoretical and scientific work will result in a great leap forward in modern
science and medicine. Furthermore, he suggests that this will revolutionize modern science
as a whole and that a second scientific renaissance will arise from Asia and benefit the entire
world.
The effect of Qigong therapy on type II DM, which has been widely observed in the
Chinese literature, suggests that Qigong practice may not only relieve the clinical symp-
toms of the disorder but also improve quality of life by controlling or alleviating same of its
complications, especially cardiovascular conditions. The literature shows that some patients
have withdrawn from all medications after Qigong therapy and report that they are com-
pletely symptom-free. This claim cannot be explained satisfactorily by the placebo effect and
deserves serious scientific exploration and examination. We hope that more investigations
will be done in this area, and that this review will serve as an introduction to the world of qi
and Qigong research.

Acknowledgments

This literature review was partially supported by a research grant from the Qigong Institute
(http://www.qigonginstitute.org) in California (USA) to Drs. Kevin Chen and Tianjun Liu.
We are grateful to Sophie Shen and Margaret June Mangaali for helping with the literature
search and putting the final report together. We also appreciate the comments and suggestions
made by Eric Manheimer, Christine Berger and Lyn Lowry on a prior version of this review.
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456 K.W. CHEN et al.

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