As Minds Open, Taiji and Qigong Gain Ground in Western Medicine

An Interview with Master Yang Yang, Ph.D.
by Dan Ferber

It's not every medical conference that has researchers dancing in the aisles. But that's what they were doing in October at the First International Symposium on Exercise Therapy, which took place at the Mayo Clinic in Rochester, Minnesota.

After Dr. Yang Yang described taiji practice as an exercise for successful aging, he had the audience stand, taught them the santi stance, began an agility drill, and cued the music. "He turned a very stoic medical crowd into a crowd that was doing basic taiji," says Dr. Steven Stovitz, a Minneapolis-based sports medicine specialist and associate professor at the University of Minnesota Medical School. "And he ended it with a beautiful two-step with Michael Jackson's music."

The two-day symposium, held at the Mayo Clinic in Rochester, Minnesota, is just the latest in a series of presentations Dr. Yang has made in recent years at major medical institutions, including the National Institutes of Health, the Dana-Farber Cancer Institute, and New York's Hospital for Special Surgery. His goal, he says, is to familiarize Western health professionals with taiji and qigong, and to foster more and better scientific research to elucidate the benefits and mechanisms of taiji and qigong practice.

His effort could benefit patients by helping doctors like Stovitz who are open to taiji and qigong healing practices but face skeptical colleagues. "Well-designed scientific studies are needed to convert people who are skeptics, which probably includes most of the physicians in the United States," Stovitz says. "But you can quickly silence critics if you can build a sound evidence base."

Speakers at the symposium, who hailed from top institutions such as the Mayo Clinic, Harvard Medical School, and Sweden's Karolinska Institute, described a variety of exercise-related topics. These included the biochemical and genetic investigation energy metabolism, mind-body interactions, and exercise therapies in patient care.

In an 80-minute presentation, Dr. Yang summarized taiji research to date to an audience of medical scientists whose names read like a "Who's Who" of exercise and energy metabolism research.

Then he described his own research on taiji's mechanisms and health benefits, and laid out potentially fruitful directions for future taiji research. Importantly, he emphasized a major limitation to most of the research done so far. The vast majority of taiji research studies to date, Dr. Yang said, have involved testing subjects who underwent only form training. This omits a crucial and once-secret part of traditional taiji training - the standing, sitting and lying-down qigong practice that builds internal energy and gong. When researchers omit this essential practice, they cannot investigate the full benefits of the art.

Dr. Yang did not just tell the assembled researchers about taiji - he showed them. He briefly demonstrated fajin to the researchers to introduce aspects of biomechanics unique to the internal martial arts. He also demonstrated push-hands to illustrate how the key components of traditional taiji curriculum are interrelated. Since researchers are skeptical by nature, Dr. Yang invited a powerful-looking young conference attendee to the stage, and asked the volunteer to try to push him. The volunteer's energetic but failed attempts to budge Dr. Yang precipitated good-natured laughter throughout the auditorium.

After he finished his lecture, Dr. Yang led the researchers through several qigong exercises to allow them to experience taiji for themselves. "Relax and imagine you're thirty years younger," Dr. Yang told the researchers, thereby communicating the importance of imagery in mind-body exercise.

Dr. Yang then invited the researchers to keep alternating the stance, with the left leg forward, then the right, then the left, then the right. Soon they were moving rhythmically to Michael Jackson's The Way You Make Me Feel. Laughter echoed through the room. "Everyone thought it was an outstanding presentation. It was definitely the most memorable presentation of the conference," Dr. Stovitz says.

To learn more about Dr. Yang's approach to taiji and qigong practice and his research, we posed a few questions:

Where did you learn taiji?

My hometown is Jiaozuo, Henan Province, China, which is about 20 miles or so from the Chen family village. I started taiji practice at the age of 12. I was born with a congenital heart defect, and was very weak and sickly as a child. The doctors had warned my parents that I may die without an operation, but that was entirely beyond the resources of my family.

I'll never forget the sense of desperation - it was a time of political turmoil in China, and with my family's difficult situation and my poor health it seemed as though there was no hope for the future. One day a visiting uncle mentioned in passing to my parents, "You live so close to the Chen village, why not try taiji?" As I mentioned in my lecture at the Mayo Exercise Symposium, even today advanced Western medicine is unavailable to many Chinese in rural areas, and traditional Chinese medicine, including qigong and taiji exercise, are the main modalities available to nurture or restore health.

After practicing under my hometown masters Yuan Shiming, Wu Xiubao, and Zhang Xitang, my health and strength improved tremendously, and I soon developed a profound appreciation for the art as well as a desire to pursue higher levels of skill and understanding. I was fortunate in eventually being able to study privately with Chen Zhaokui and Gu Liuxin, both 18th-generation grandmasters of the Chen style.

While attending college in Shanghai in 1982, I was introduced to Grandmaster Feng Zhiqiang, who had been invited there as the 18th-generation representative of the Chen style to a historic taiji symposium, the first in which masters from the five major styles all came together to demonstrate. At the symposium, Grandmasters Fu Zhongwen and Yang Zhendou were there for the Yang style, Ma Yueliang and Wu Yinghua for the Wu style, Feng Zhiqiang, Hong Junshen and Chen Xiaowang for the Chen style, and Sun Jianyun for the Sun style.

I had heard many stories of Grandmaster Feng and was very eager to meet him, but at that time he did not teach openly, and one had to be recommended and introduced by a trusted colleague. I was fortunate that Master Chen Xiaowang introduced me to Master Feng in Shanghai, and I became Master Feng's student after that meeting. Later I moved to Beijing to live and study with Master Feng, and I eventually became his disciple in 1988. At that time the teacher-student relationship was very traditional.

While traveling to my hometown area to teach in the Chen Village, Grandmaster Feng visited my home to meet my parents before he accepted me as a student. This is a very traditional Chinese way. The word "shifu" literally means teacher-father, and the teacher would traditionally vet potential students, including their familial relationships, before taking them on to teach. There was also no money exchanged - instead, I performed chores for Grandmaster Feng and his family in exchange for instruction.

Only a small number of my taiji brothers and sisters studied with Grandmaster Feng in this traditional way before he opened his teaching to the public. I must say that much of the information about taiji and qigong that I am able to share with the taiji community and with researchers comes from Grandmaster Feng and his lineage through Grandmaster Chen Fake and the xinyi and qigong Grandmaster Hu Yaozhen. We all owe these great masters a debt of profound gratitude both for their life's dedication in mastering taiji and qigong and in unselfishly sharing their knowledge with their students.

How or why did you get involved in taiji and qigong research?

I have long advocated that research using the scientific method is important if the many potential benefits of taiji and qigong practice are to be widely known and accepted in mainstream Western culture. This was why I took a doctorate degree in kinesiology at the University of Illinois. I also wanted to deepen my own understanding of taiji.

The decision to enter the academic world was not an easy one. After I graduated with a master's degree in economics from Illinois State University in 1995, I was offered a lucrative position as the president of Chinese operations of an American casting company. But I also intended to continue practicing and teaching taiji. Indeed, when I accepted the title of disciple from Grandmaster Feng, I had taken an oath to continue promoting taiji and qigong, a treasure of Chinese culture. Though the prospect of another five years as a poor graduate student gave me pause, now I believe that my decision to pursue academic study greatly enhanced both my understanding of the art and my ability to teach others and to promote holistic wellness.

Can you summarize the findings of taiji research so far?

The number and quality of scientific studies has increased dramatically in the last 10 years, especially the last 5 years. From 1990-2000, the number of studies, and quality of evidence, for any clinical area was still quite small, according to a recent review of the past twenty years of taiji studies by Dr. Penny Klein of D'Youville College, Buffalo, NY and her colleagues. This is a perfectly normal trajectory for research. Less rigorous but less costly studies are typically done first to demonstrate potential or proof of concept. Then researchers are able to justify more rigorous and more expensive trials. We have a long way to go.

Dr. Klein and her colleagues concluded that there is strong evidence that taiji is effective for improving balance and reducing falls and the fear of falling, enhancing cardiopulmonary function and immune function, easing osteoarthritis and improving bone health, and easing pain and stress and the deleterious effects of aging, and improving the quality of life. There is conflicting evidence on whether taiji can help with diabetes, Parkinson's disease, fibromyalgia, and weight loss. However, in September Chenchen Wang and her colleagues of Tufts University Medical Center did publish a paper in the New England Journal of Medicine reporting that taiji was effective in treating fibromyalgia.

What taiji research studies have you been involved in?

So far I've been involved in studies that have evaluated the effect of taiji and qigong on lower body strength, functional balance and balance mechanisms, immune function, and quality of life for older adults. One of the more interesting results came from one of my earlier studies. We measured lower body strength (specifically, knee extensor strength) and force control (variability of force output). We showed that in older adults taiji and qigong practice concurrently improved both lower body strength and the ability to control force output. Every other type of exercise tested improves one or the other, but not both. This finding suggests that neuromuscular mechanisms in taiji and qigong differ from those in other forms of exercise.

What did you mean when you said we have a long way to go with research?

First, past studies have had many methodological problems. For example, researchers have been lax in describing the interventions in publications: it is not even possible to know by reading many studies what exactly the intervention was.

Only 2 of 31 randomized controlled trials (RCTs) that were summarized in a 2009 review paper explained what a taiji session consisted of and whether non-taiji exercises were also included in a training session. It is not possible to replicate the experiment if it is not described in detail.

Also, about half of the studies were not blinded. (In medical studies "blinding" means that the people who make the measurements don't know whether the subject has received the treatment or is in the control group. It's well established that bias can occur if the person making the measurement knows which groups the subjects are assigned to).

We also need research to understand the mechanisms of taiji and qigong, or how or why taiji and qigong work. Most of the studies to date have focused on whether taiji helps treat a specific clinical problem, and they contain no hypotheses to explain the results, so they don't help researchers who want to understand how and not just if a treatment works.

Studies that explore mechanisms of taiji and qigong will gradually increase our knowledge, which will lead to development of further hypotheses. Research in Eastern mind-body traditions will ultimately improve Western science's understandings of the workings and potential of the human body. At the same time, this knowledge will improve our understanding of the internal martial arts, and thereby make our practice all the more efficient. Both sides win.

Determining how taiji works will not be a simple matter. Unlike pharmaceuticals, which act via a specific molecular or cellular mechanism, mind-body interventions act non-specifically. By this I mean that they regulate highly complex, interconnected systems - for example, immune and nervous system function and interaction. Experts from diverse areas of science will need to collaborate to devise mechanistic hypotheses that help explain the benefits of mind-body exercise.

Third, we need to evaluate trial design to tease out the effective components of taiji training. The standard method used to test pharmaceuticals, a placebo-controlled trial, don't work for mind-body.

Mind-body treatments are considerably more complex than treatment with pharmaceuticals. The effectiveness of a new drug is typically tested in a trial that is double-blinded, which means that the subjects themselves do not know which treatment they received. In a trial of taiji and other mind-body modalities, the subjects will know which treatment they have received. Gold-standard pharmaceutical trials are also placebo-controlled, meaning that patients receive either drug or a sugar-pill that they can't distinguish from the drug. Placebo controls are difficult to achieve for trials of mind-body interventions.

Unlike a drug, which acts via a single cellular mechanism, mind-body interventions like taiji exert their effects in multiple ways simultaneously. According to a recent paper by Peter Wayne and Ted Kaptchuk of Harvard Medical School, these include musculoskeletal strength and flexibility training, deep breathing, mindfulness, visualization and intention, and massage or gentle touch, psychosocial interaction, ritual and spirituality. Which are the effective ingredients? Do they work together? Is it possible to create a placebo, or "sham" taiji intervention to assess the efficacy of taiji versus a placebo? Is it necessary? All these questions remain to be answered.

There is a famous old saying in China: "Relaxation and tranquility are the reasons why qigong can heal you." But which of the different components of taiji training cause the relaxation? Is it teacher-student interaction? Is it the curriculum? Is it friendly social interactions with the teacher and with classmates? Is it ritual, environment, or belief? Or is it all of the above? So far no one knows.

Fourth, the concept of dosage is central to clinical application. Doctors and patients both want to know the minimum amount of taiji needed to cure or alleviate a particular condition. This is not simple either. The dosage of a drug is easily determined, but the "dosage" of taiji is a function of both quantity and quality of practice. Ten minutes of high quality practice delivers a higher dose of taiji than an hour of poor-quality practice. Quality, in turn, is a function of the teacher's aptitude, his or her willingness to share the art, and the student's understanding and effort. So you can see that assessing dosage is a much more complex issue for mind-body interventions.

Fifth, we need to compare curriculum in scientific trials to determine the most efficient taiji program. Actually, the masters have already done this work for us. Over the centuries past masters have experimented, through trial and error, to determine how to get the most benefit in the shortest amount of time. In their own way past masters were reductionist scientists.

Their combined wisdom, passed down over the generations through written and oral traditions, teaches us that the essential pillars of efficient taiji practice are static and moving qigong, form, and push-hands. These training methods are interrelated and synergistic - each exercise builds upon skills developed from the others, and the combined effects of correct practice of all exercises are greater than practice of individual exercises.

The written and oral tradition of taiji emphasizes that sitting and standing meditation (wuji) is the starting point for efficient taiji practice. You have to learn how to relax your mind and body in stillness before you can relax in form movement. You have to learn how to relax in form movement before you can relax while perturbed during push-hands. Perhaps the most well-known saying in the internal martial art tradition of China is lian quan bu lian gong, dao lao yi chang kung. (If you practice form, but not qigong, even if you practice your whole life, your art will be empty.) Very few research studies to date have mentioned this essential aspect of traditional taiji practice. The researchers and possibly the taiji instructors themselves are not yet sufficiently aware of this core tradition of the internal arts.

Can you give an example from your own practice that demonstrates the importance of this curriculum?

Sure. Before I met Grandmaster Feng in Shanghai in 1982 I was the three-time champion of the Shanghai all-university taiji competition. After the third year I was awarded the title of "best overall martial artist," and was given a position as taiji coach at the Shanghai Chen Style Taiji Research Association. Actually, I was teaching Chen style taiji in the same building that Grand Master Fu Zhongwen was teaching Yang style. When it rained we shared the same room for our classes. I thought I knew a lot about taiji.

I met Grandmaster Feng in his hotel room. He said, "Okay, you are the champion; show me your push-hands." I thought okay, but I will be gentle with this older man. Not only could I not budge him in the slightest, but I could not even stand in front of him - he immediately threw me this way and that, my falls broken by the furniture in the room. (I was grateful it was a small room.) His next words are indelibly etched in my memory. He said, "Boy, you are the champion, but you have not even entered the taiji circle yet." To which I immediately inquired, "Laoshi (teacher), how do I enter the circle?" He taught me that day, and for years after how energy-nurturing meditation (qigong) is essential for efficient taiji practice, and how wuji (no extreme) is the mother of taiji (grand extreme). This too, is a very famous saying in China, but it has been my experience that few fully understand its meaning, or how to apply it to daily practice.

This story also illustrates that accomplishments and titles are all relative. I was the three-time champion, the "best overall martial artist," and I was coaching at the Shanghai Chen Style Taiji Research Association. But I learned that day that I really knew very little. Before I met Grandmaster Feng, I used to put 40 small pebbles in my pocket, and each time I completed a form I would toss one pebble out. That way, I was sure to do 40 form repetitions every day. I gained certain benefits, but it was a very inefficient way to practice.

I'll give an example from my research that demonstrates the importance of energy-nurturing meditation for efficient practice. In one of my published studies, we treated older adults with a mean age of 80 with the flu vaccine and measured their immune response. Taiji and qigong practitioners showed a significantly improved response compared with the control group after only three weeks of practice.

At that point, the participants had practiced standing and sitting qigong meditation and several moving qigong exercises, but they had not learned the seven-movement taiji form that I created for research. I fully believe that we would not have seen anywhere near as great a benefit in immune function if we had merely taught the subjects to memorize choreographed physical movement. I designed the research curriculum to be a representative sampling of my traditional training, and that meant emphasizing the essential foundation of nurturing energy.

What did you hope to accomplish at the Mayo Clinic-Karolinska Exercise Symposium?

My goal was to introduce the methods and purposes of traditional taiji training to this distinguished group of exercise scientists, and to emphasize the difference between the "no pain, no gain" Western concept of exercise that they know with the nurturing "no pain, more gain" approach of taiji and qigong exercise. In so doing, I hoped to spark their interest in taiji research.

As I mentioned, I believe that researching the mechanisms of taiji and qigong is important for the future of the art. Why do we have the combined feeling of peacefulness and more energy after practice? Can known mechanisms of energy metabolism explain that, at least in part? Can we understand the physical mechanics of taiji movement and explosive force exertion (fajin), which are quite different from those known to Western sports performance scientists? I would expect that that would pique their interest.

Although I said that there is still a long road ahead of us, I should emphasize that we have already come a long way. Two years ago I was invited to be a keynote speaker at a National Institutes of Health (NIH) symposium on mind-body medicine. My host admitted that ten years ago this conference would not have been possible because mind-body medicine was still considered unscientific woo.

It's very encouraging now see that mind-body medicine is being embraced at the highest levels of government and academia, thanks to hard work by all taiji teachers, researchers, and students.

It's up to the researchers now to produce a sound body of high-quality evidence-based science. And it's also up to the traditional taiji and qigong community to maintain the highest integrity when presenting taiji and qigong to the public.

Although taiji is one of the best exercises for self-defense and well-being, most people in America still do not know what taiji and qigong are. Quality scientific studies using the essential curriculum are needed to popularize taiji and qigong practice in mainstream Western culture. I believe that such research on the benefits of taiji and qigong, along with a sincere desire to share the art with the students, will help us reach the ultimate goal - to share this ancient holistic mind-body practice with the general public.

We do not need to hide any secret in our teaching. We are all human beings, we all have insecurities. But if we openly, genuinely, and generously share our art, we will grow and become better during this sharing process, and the art will continue to grow too.

I have to admit that I was not sure if the general public would embrace taiji and qigong when I completed my graduate work in 2005. But the more presentations I do, the more meetings I have with physicians and researchers, and the more projects I am involved with, the more I am convinced that we will get there. Taiji and qigong will contribute to successful aging in all of mankind. And more people will live as "longer, happier, kinder, stronger, and wiser."

Yang Yang, PhD, is the author of Taijiquan, The Art of Nurturing, The Science of Power and is the Director of the Center for Taiji & Qigong Studies, New York, New York.

Dan Ferber is a freelance science writer and long-time student of Dr. Yang Yang. He teaches Taiji and Qigong in Indianapolis, Indiana.

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Written by Dan Ferber for KUNGFUMAGAZINE.COM

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