Related Terms

• Chi, Dao, Daoism, qi.

Background

• Taoism is the English name that covers a variety of Chinese religious and philosophical beliefs. This religion has a very long history, and has influenced the development of a variety of modalities used in health and healing, from macrobiotic diets to electroacupuncture.

• Taoism is sometimes used to describe various Chinese folk religions. Many of the estimated 225 to 400 million individuals called Taoists would not identify themselves as followers of this religion. Though Taoists may have very different and conflicting belief systems, which vary by social group, there are spiritual and philosophical commonalities that they all share. This group of belief systems, collectively known as Chinese medicine, has influenced the development of meditative, exercise, and medical practices for over 2,000 years. The primary uniting factor among all Taoists is the belief that the human body is a microcosm of the universe, which means that the forces that influence the events of the outside world also work on a smaller scale within each person. Taoists believe that energy flows through the universe, and that a willingness to be flexible to the forces that drive the universe inside as well as outside of the body is the most important means of maintaining health and wellbeing.

• Taoism is thought to have been founded by Lao-tzu, whose name is also written Lao Zi. He preached that life's ultimate principles could be found by observing nature. For instance, Lao-Tzu used the metaphor of flowing water. Although water is soft, yielding, and weak, it can carve stone and move earth over time. Following the natural direction of energetic forces is the emphasis of this metaphor.

• The ancient Chinese philosophy of Taoism provided the basis for the development of Chinese medical theory and has influenced the development of various healing practices and modalities including: Asian bodywork, acupressure, acupuncture, acustimulation, Asian body work, chi kung, cupping, electroacupuncture, energy-based bodywork, macrobiotics, moxibustion, feng shui, meditation, qi gong, tai chi, shiatsu, taiji, tuina, traditional Chinese medicine, and various martial arts.

• Taoism is not considered a mode of healing, but a thought system of attuning one's self to exist in the rhythms of the life force or "qi."

• Chinese medicine is a broad term encompassing many different modalities and traditions of healing, which share a common heritage of technique or theory rooted in ancient Chinese philosophy (Taoism) dating back over 5,000 years. Given the distribution of the world population, it is likely that more people have been treated by Chinese medicine in its various forms than any other therapy in history. There are many possible ways to categorize the modalities and traditions of Chinese medicine.

• The term traditional Chinese medicine (TCM) is actually a recent development with a specific meaning in the long history of Chinese medicine. In the 1940s and 1950s the Chinese government undertook an effort to combine many diverse forms of Chinese medicine into a unified system to be officially defined as traditional Chinese medicine. The term traditional Chinese medicine (TCM) applies to a specific standardized form of healing system that was sanctioned and codified by the Chinese government during the period of time called the Great Leap Forward. The history and oral traditions of other modalities were lost to some extent during the 1950s, due to government repression of other health practices influenced by Taoism. The intent was to integrate the country's large workforce of traditional practitioners into an organized health service delivery system, which would aid in providing care for a large population by using familiar and inexpensive methods. Today, Chinese medicine refers to all of the many healing traditions that were influenced by Taoism but that have not been included under the heading of TCM.

• Taosim has become a religion of increasing interest in the West since the 1970s. Chinese medicine comprises many related but individual modalities, each with its own body of research, with varying degrees of scientific support. Natural Standard monographs are available for reviews of evidence for the following modalities employing principles of Chinese medicine: acupressure, acupuncture, acustimulation, Asian body work, chi kung, cupping, electroacupuncture, energy-based bodywork, macrobiotic diet, macrobiotics, moxibustion, Qi gong, shiatsu, tai chi, taiji, traditional Chinese medicine (TCM), and tuina.

Technique

• At present, it is not known which of the modalities influenced by Taosim is the most cost effective or therapeutically effective. Research in China focuses on case studies rather than large clinical trials, and the diagnostic categories of Taoism assigns each patient a unique pathology, making Taoist treatments difficult to research in Western-style medicine. Further, most of the healing systems influenced by Taoism do not regard any person as existing in an ideal state of health, rather every person is thought to have an inbalance of some kind.

• According to Taoist philosophy, nature and the laws that govern the on-going harmonious flow of life energy through the natural world are used to better understand the body and health. Each person is viewed as an ecosystem that is embedded in and related to the larger ecosystem of nature and is thus believed to be subject to the same laws.

• The life force, chi (qi), is believed to circulate through the body and enliven it. Health is seen as a function of a balanced harmonious flow of chi, and illness results when there is a blockage or an imbalance in the flow of chi. Yin and yang are opposite and complementary qualities of life energy (chi); yin is regarded as the feminine principle, and yang the masculine principle.

• The human being is thought to have a system of pathways called meridians (also sometimes called channels) through which chi flows. The body has been mapped with these meridians, which pass through all its organs, and specific meridians correspond with specific organs or organ systems (also called organ networks). Health is believed to be an ongoing process of maintaining balance and harmony of the circulation of chi through all the organs and the systems of the body.

• Symptoms are regarded as signals of impaired flow or circulation of chi through the body and are considered as part of a larger picture or pattern affecting the whole person. The practitioner seeks to connect seemingly unrelated symptoms and come up with a unifying explanation. This unifying explanation uses a unique diagnostic system that incorporates every symptom into a diagnosis.

• Harmony and disharmony are understood in two main conceptual frameworks: the eight principles and the five elements.

• The eight principles are actually four pairs of complementary opposites describing patterns of disharmony within the person. These pairs are not always important in Western medicine, but in healing systems influenced by Taoism, these details provide clues as to the flow of qi in the patient's body. The eight principles are: interior/exterior, referring to the location of the disharmony in the body (internal organs vs. skin or external qi); hot/cold, referring to qualities of the disease pattern (such as fever or thirst vs. chilliness or desire to drink warm liquids); full/empty, referring to whether the condition is acute or chronic, and whether the body's responses are strong or weak; and the balance of yin/yang. The eight principles are the theoretical basis of all Taoist-influenced modalities.

• Five element theory is the basis of the approach called traditional acupuncture (also referred to as classical or five element acupuncture). The five elements are fire, earth, metal, water, and wood. These terms do not refer to basic constituents of matter, but are seen as dynamic qualities of nature and are used to describe the changing qualities of chi energy as it circulates through the person.

• The body is thought to have five organ networks, each corresponding with a particular element: heart/small intestine with fire, spleen/stomach with earth, lungs/large intestine with metal, kidneys/bladder with water, and liver/gall bladder with wood. The organ networks are named for the common meridian or energy pathway that circulates through and connects the organs, as it circulates chi throughout the larger body-wide meridian system. The organ systems of Taoist-influenced modalities do not have a corollary in Western medicine and do not refer to clearly defined body tissues. Rather, the organ systems are a complex grouping of symptoms that identify a patient's overall sense of wellbeing. The practitioner's efforts to harmonize the five elements are thought to promote greater harmony in the functioning of all the organ networks.

• Acupuncture / Traditional Chinese Medicine (TCM): The practice of acupuncture originated in China approximately 5,000 years ago. Today it is widely used throughout the world and is one of the main components of Chinese medicine. Based on acupuncture's long history of use as well as the limited research available, both the World Health Organization and the National Institutes of Health have identified many conditions for which it may be recommended. However, many common uses of acupuncture or TCM do not yet have formal scientific evidence to support them. Aside from needles, other methods of stimulation are also considered forms of "acupuncture." These include the use of heat from the burning of herbs placed on meridian points ("moxibustion") and the placement of herbal pastes on any of the 365 commonly used meridian points in TCM. Over 320 meridian points may be used for moxibustion.

• Acustimulation / TENS / electroacupuncture: Acustimulation is the mild electrical stimulation of acupuncture points. A low intensity electrical current is used to penetrate just slightly below the surface of the skin. It may be delivered by acupuncture needles attached to electrodes or more commonly, by battery-powered appliances that can be worn on the body (touching the surface of the skin). The Neiguan point (P6) is an acupuncture point between two of the tendons on the wrist, which is about two "cun" medial from the crease of wrist. Its exact location is determined by a measurement system called "cun," which takes into account proportions of the patient's body as landmarks rather than a codified marker of distance for every patient. The Neiguan point is the most common point used in acustimulation.

• Asian body work / shiatsu / tuina: The practice of applying finger pressure to specific acupoints throughout the body has been used in China since 2000 BC, prior to the use of acupuncture. Acupressure techniques are widely practiced internationally for relaxation, wellness promotion, and the treatment of various health conditions. Multiple human studies suggest effectiveness of wrist-point (P6) acupressure for treating nausea. Shiatsu means finger (Shi) pressure (Atsu) in Japanese. Shiatsu technique involves finger pressure at acupoints and along body meridians. It can incorporate palm pressure, stretching, massaging, and other manual techniques. Shiatsu practitioners commonly treat musculoskeletal and psychological conditions, including neck/shoulder and lower back problems, arthritis, depression, and anxiety. Tuina (Chinese for "pushing and pulling") is similar to shiatsu but uses more soft tissue manipulation and structural realignment. Tuina is a common form of Asian bodywork used in Chinese-American communities.

• Auriculotherapy: Auriculotherapy applies the principles of acupuncture to specific points on the ear. It is a treatment modality where the specific malfunctioning organ or a systemic illness can be treated by application of a laser and/or a TENS (transcutaneous electrical nerve stimulation) unit to a correlating part of the external ear. The point on the ear is located according to a somatotopic map, where each part of the auricle, or external ear, corresponds with a body part or energetic system. The most popular somatotopic map is the "inverted fetus" image, where the organs correspond to the superimposed image of an upside-down fetus. However, at least four other maps exist to locate and treat malfunctions of the body. These maps use different images of a fetus to locate points and may correlate points on the ear with Western-style organ systems. Practitioners may use the somatotopic map to correct imbalances or disease in nearly any part of the body. The points used in auriculotherapy are located by skilled palpation of the ear with a special instrument and the observation of the patient's reaction to this palpation. Auriculotherapy is most popularly used to help with detoxification from any sort of substance abuse and chronic pain. Some hospitals offer auriculotherapy for post-operative pain management, and some detox centers provide auriculotherapy for the treatment of drug addiction. During a typical treatment, the practitioner, called an auriculotherapist, takes the complete medical history of the patient. The practitioner often examines the ear for slight variations in coloring, flaking skin, large veins, and other topical irregularities. The ear may also be palpated for patient sensitivity with the finger or special instruments. Treatment focuses on the presenting concern of the patient. Sessions may be as brief as 10 minutes or may last as long as an hour. The duration of the therapy varies according to the response of the patient to treatment and the severity of their condition. Auriculotherapists perform this therapy with a variety of tools, including a TENS unit, a laser, press balls, or a magnet. Though a TENS unit involves the insertion of needles on the ear, the needles are not similar to those used for acupuncture.

• Cupping / moxibustion: Cupping and moxibustion are healing techniques that have been employed across the diverse traditions of acupuncture and oriental medicine for over 2,000 years. In modern times, both methods are usually used to complement acupuncture with needles, but they may be used independently. Cupping and moxibustion share the principle of using heat to stimulate circulation and to break up congestion or stagnation of blood and chi. Cupping has some relation to the massage technique tuina, which uses rapid skin pinching at points on the back to break up blood congestion and stimulate circulation. Moxibustion is more closely related to acupuncture as it is applied to specific acupuncture points, such as those whose primary energetic function is to move stagnated qi while cupping may be used in locations other than acupuncture points. The literature on these techniques consists predominantly of opinion based on clinical experience, case reports, and a few case series reports in which the methods of observation and analysis are not clear or consistent. This does not mean the techniques do not work, but that little of what has been reported can be evaluated as scientific evidence.

• Energy-based bodywork / polarity: Bodywork is thought to remove energy blockages and strengthen energy fields. Dietary changes (believed to purify or build health), counseling, yoga, craniosacral therapy, and other bodywork techniques may be employed. The dietary changes assign energetic properties to particular foods, which, when properly combined and eaten, influence the complex energetic systems within a person to move towards a state of wellbeing. Craniosacral therapy is an energetic system which focuses on soft palpation and manipulation of the spine to help a patient achieve a more balanced state of health. There is limited scientific study of the effects of polarity in humans. There are anecdotal reports of improvements in pain and anxiety/stress, and some relief from the side effects of surgery, chemotherapy, or radiation therapy (including nausea, hair loss, neuropathy/nerve pain, radiation burns, or hardening/scarring of tissue in mastectomy patients). Polarity therapy has also been used as an adjunct therapy for cancer. However, these effects have not been thoroughly evaluated or proven with scientific research. Sessions usually take 60 to 90 minutes. Duration of treatment may vary, but one session per week for up to eight weeks with occasional follow-up treatments to maintain health may be suggested. Dietary advice may also be suggested based on the concept that the types of foods and the ability to digest foods may cause blockages in energy fields.

• Macrobiotic diet / macrobiotics: The modern practice of macrobiotics was started in the 1920s by the Japanese educator George Ohsawa. He is said to have cured himself of a serious illness by changing to a simple diet of brown rice, miso soup (soup created from fermented soybeans), and sea vegetables (such as seaweed). Macrobiotics is a predominantly vegetarian whole-foods diet that emphasizes whole grains (especially brown rice), vegetables, fruits, legumes and seaweeds. Some proponents eat white meat or fish once or twice a week while others eat no animal products whatsoever, an approach referred to as "vegan". Macrobiotic diets may be individualized based on factors such as climate, season, location, age, gender, activity, and health needs. Foods are classified into yin and yang categories according to their various properties and their effects on the body. The tastes of foods (sour, bitter, sweet, pungent, salty) determine how they will interact with each other. The interactions of foods with each other and the body are determined according to a patient's specific diagnosis of pathology, as well as the principles of qi in the body.

• Qi gong / chi kung: Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. There are two main types of Qi gong practice: internal and external. Internal Qi gong is a self-directed technique that involves the use of sounds, movements, and meditation. Internal Qi gong actively engages people in their own health and well-being and can be performed with or without the presence of a master instructor. It may be practiced daily to promote health maintenance and disease prevention. External Qi gong, also known as qi emission, is performed by a Master using his or her hands on a patient with the aim to project qi for the purpose of healing. There are many different styles of Qi gong; the Chinese government has reported over 5,000 types.

• Tai chi / taiji: Tai chi is a system of movements and positions believed to have been developed in 12th Century China. Tai chi techniques aim to address the body and mind as an interconnected system and are traditionally believed to have mental and physical health benefits to improve posture, balance, flexibility, and strength. Many styles of tai chi have developed since the original set of 13 postures, each a positioning of the body intended to influence or move the qi in specific ways through the patient's body. The modern practice of tai chi often includes sequences of slow movements coordinated with deep breathing and mental attention. Specific forms or poses may last from 5 to 30 minutes. Tai chi is taught in classes or can be practiced alone. Classes often include fewer than 20 people. Instructors guide students through movements and encourage them to keep their bodies stable and upright while shifting weight. A high level of concentration is usually involved, and sessions are intensely focused and quiet. Exercises can also be practiced alone daily, often in the morning, for 15 to 20 minutes.

Theory/Evidence

• Several traditional Asian medical philosophies consider health to be a state of balance in the body, which is maintained by the flow of life energy along specific meridians. A disease state is believed to occur when energy flow is blocked, or if energy is deficient or in excess. It is believed that there are 12 primary channels and eight additional pathways circulating life energy throughout the body and maintaining the balance of yin and yang.

• Acupuncture: Western science has studied electrical phenomena (ions, electrons, electrical energy) that occur with acupuncture. These phenomena are detectable and appear to accompany the circulation of chi through the body. Meridians and points identified in Chinese medicine coincide with anatomical features that can be observed with scientific instruments. For example, electrically-charged particles called "ions" have been found to flow through "ionic streambeds" that correspond with the meridians just beneath the surface of the skin. Acupuncture points have been found to emit light, which can be detected with sensitive laboratory equipment. However, the chi (vital energy, life force) proposed by Chinese medicine theory is not electricity and may not always be directly detectable with scientific instruments.

• Acupuncture has been shown to effectively treat some health conditions, including pain. However, the mechanism of action remains unclear. Endogenous opioid-mediated mechanisms of electroacupuncture as used in China only appear to partially explain how acupuncture may work. Acupuncture is purported to also affect the brain's reward systems and blood flow in the skin, muscle, and nerve cells. Research has shown regional effects on neurotransmitter expression as well. However, the existence of "chi" cannot be directly confirmed. One of the challenges in reviewing acupuncture and other complementary practices is the lack of a placebo or sham-group in most clinical trials. Some experts argue that blinding and placebo controls are not necessary because when they are used, they are often not a true placebo. Recent study investigated a sham retractable type acupuncture needle and found that the applicability of "placebo" needling may be influenced by inter-tester variability, as well as the patient's knowledge and experience of acupuncture, acupuncture point selection, and the visual impact of needling.

• Acustimulation / TENS / electroacupuncture: Acustimulation is a distinct modality from acupuncture. However, it borrows from Chinese acupuncture theory to locate points on the body where electrical stimulation, as an alternative to needles, may be applied to reduce certain symptoms. Western science explains the effects of acustimulation in terms of affecting the nervous system, rather than the circulation of chi (vital energy, life force) which is the basis of Chinese acupuncture theory. The system of chi pathways ("meridians") used in Chinese acupuncture theory is thought to have certain parallels with the nervous system, such as the chi pathways that control the release of certain hormones. This makes it possible to use the Chinese map of acupuncture points to identify locations where electrical stimulation may influence certain responses of the nervous system. Nausea and vomiting are believed to be caused by disturbances in the normal nerve impulses passing between the brain and stomach. Acustimulation uses a mild electrical current at the wrist to modulate these nerve impulses and restore normal signals between the brain and stomach, thus reducing nausea and vomiting.

• Asian body work / shiatsu / tuina / acupressure: Several traditional Asian medical philosophies consider health to be a state of balance in the body, which is maintained by the flow of life energy along specific meridians. A disease state is believed to occur when energy flow is blocked, or when energy is deficient or in excess. A goal of acupressure is to restore normal life energy flow using finger and palm pressure, stretching, massaging, and other bodywork techniques. It is believed that there are 12 primary channels and eight additional pathways circulating life energy throughout the body and maintaining the balance of yin and yang. It is proposed that acupressure may reduce muscle pain and tension, improve blood circulation, release endorphins, and release/eliminate toxins. The mechanism of action may be similar to other techniques such as acupuncture (stimulation of acupoints with needles), moxa (touching the skin with a burning stick including dried mugwort leaves), or other forms of manual stimulation. Techniques that involve soft tissue manipulation may have similar effects on the body as therapeutic massage.

• Auriculotherapy: Whereas the acupuncture diagnostic and treatment system focuses on paths of energy running through the body, auriculotherapy focuses on connections between the ear, the affected organ(s), and the central nervous system. While ear acupuncture uses needles without an electrical current, auriculotherapy uses a TENS unit or a laser. The capability of reflex points on the external ear to alter neuromuscular and neuropathic disorders has been attributed to the descending pain inhibitory pathways of the central nervous system. The inverted fetus perspective of the somatotopic arrangement of auricular acupuncture points was first described in the 1950s by Dr. Paul Nogier of France and has received scientific support from double-blind studies examining the auricular diagnosis of musculoskeletal and coronary disorders. Acupuncture points on the ear and on the body have lower levels of electrical skin resistance than surrounding tissue. These electrodermal differences are apparently related to autonomic control of blood vessels rather than increased sweat gland activity. The heightened tenderness of reactive acupuncture points may be explained by the accumulation of noxious subdermal substances. Electrical stimulation of specific points on the external ear leads to site-specific neural responses in different regions of the brain. Behavioral analgesia produced by auricular acupuncture may be blocked by the opiate antagonist naloxone, which indicates the role of endorphinergic systems in understanding the underlying mechanisms of auriculotherapy. The anatomical structures and electrical application of the auricle are described as they relate to the localization of master points, musculoskeletal points, internal organ points, and neuroendocrine points. The scientific community has not reached a consensus on the efficacy of auriculotherapy. Most trials of this practice are of poor design quality, and the results are often difficult to analyze.

• Cupping / moxibustion: The actions of cupping and moxibustion are explained by theory from acupuncture and Chinese medicine. Specifically, health and illness are believed to be manifestations of the circulation of chi (vital energy or life energy) through the body. These techniques are used to influence the circulation of chi or to alter its subtle qualities in order to relieve symptoms in the body. Heat is believed to be a potent force for influencing the flow or qualities of chi throughout the body. Historically, one theory of mechanism of action of moxibustion is that the local tissue damage (extended cellular damage by the intense heat of moxibustion) initiates a non-specific healing reaction that can have effects throughout the body, and is stimulated by production of immunological mediators and neurotransmitters. It has been proposed that moxibustion elevates immune responses and stimulates the circulation of white blood cells in the body. Moxa may have antiseptic (antibacterial) and analgesic (pain-relieving) effects, possibly due to one of its components, borneol, which is commonly applied to the skin. Moxibustion may improve circulation and enhance localized drug uptake in areas of the body being targeted by therapeutic drugs.

• Energy-based bodywork / polarity: Polarity is based on a theory that energy flows through the body along five predictable pathways, and that this flow can be affected by the placement of therapeutic hands at specific points to correct disorders or imbalances. The pathways flow along paired organ systems. It has been hypothesized that cells in the body have negative and positive poles that are involved in this flow of energy. Polarity therapists believe that the clockwise flow between the positive and negative aspects of the body's electromagnetic field must be in balance and flow freely to maintain health. The spinal column is thought to have five neutral energy centers (ether, air, fire, water, and earth), with each of these areas corresponding to a variety of bodily processes and functions. Practitioners aim to access a patient's energy using palpation, observation, and patient interviews. Polarity shares some principles with the yin-yang concept in traditional Chinese medicine (TCM) and the chakra system in Ayurvedic medicine. Polarity providers believe that the maintenance of good health requires free flow of life energy through the body, without areas of excess or depletion. Polarity therapy uses four different approaches with the goal of balancing life energy: body work, nutrition, exercise, and counseling. A session may consist of bodywork treatment and a combination of work in the other three areas. An overall goal of the polarity approach to health and well-being is to give clients multiple tools to use in maintaining a balanced way of life. Responsibility and self-esteem are also often encouraged.

• Macrobiotic diet / macrobiotics: At the heart of macrobiotics are the concepts of yin and yang, which were identified in Taoist Chinese philosophy as two principles which complement each other as life unfolds. Yin represents expansion, coolness, and passiveness while yang represents contraction, heat, and aggressiveness. In the macrobiotic view, the forces of yin and yang must be kept in balance to achieve good health. The food groups that have the least pronounced yin and yang qualities, grains and vegetables, are emphasized in macrobiotics. Eating these foods is thought to make it easier to achieve a more balanced condition within the natural order of life. Foods considered extremely yin or extremely yang are avoided, and combining foods is planned to achieve a balance of tastes.

• Qi gong / Chi kung: Qi gong is believed to be beneficial for three principal purposes: spiritual enlightenment, medical care, and martial arts/self-defense. Medical Qi gong may involve internal or external techniques and often includes five steps: meditation, cleansing, recharging/strengthening, circulating, and dispersing qi. Each step includes specific exercises, meditations, and sounds. Qi gong is intended to be harmonious with the natural rhythms of the environment and has been described as "a way of working with life energy."

• Tai chi / taiji: In traditional Chinese medicine, illness may be viewed as the result of imbalance between two opposing life forces, yin and yang. The practice of tai chi aims to reestablish balance, which creates harmony between body and mind and between the individual and the outside world. It is said that in the 13th Century, Taoist priest Chang San Fang observed a crane fighting with a snake and compared their movements to yin and yang. Some techniques of tai chi were based on movements mimicking these animals. In modern times, tai chi is a physical exercise that when practiced regularly may increase muscle strength. Preliminary scientific evidence suggests that better cardiovascular health, coordination, and balance may occur from regular tai chi practice.

Safety

• Since the Chinese medicine treatments influenced by Taoism cover so many different therapies and modalities, the information below includes only examples of safety concerns with selected herbs, supplements, and modalities.

• Acupuncture: Acupuncture is generally reported as a safe procedure when performed by an experienced practitioner using standard sterile techniques. Needles must be sterile in order to avoid disease transmission, and most practitioners now use disposable needles. Rare serious and potentially lethal complications have been noted including infection, and organ, nerve or vascular injury, such as cardiac tamponade (a medical emergency where fluid gathers around the lining of the heart). There are several reports of fatalities in the available medical literature. Acupuncture may be unsafe when performed on patients with emphysema or other pulmonary disease due to multiple case reports of pneumothorax. It may also be unsafe when used on elderly or medically compromised patients, on diabetics due to poor circulation, or on patients with a history of seizures. Acupuncture should be avoided in the following conditions: valvular heart disease, known bleeding disorders, use of anticoagulant drugs, unstable medical conditions or infection, pregnancy (may induce unwanted labor and possible miscarriage), systemic or local infection, pain of unknown medical origin, medical condition of unknown origin such as dermatologic lesions, and neurologic disorders. It has also been suggested that acupuncture should not be applied to areas that have received radiation therapy.

• Acustimulation / TENS / electroacupuncture: The only currently reported side effect of acustimulation devices is slight skin irritation under the electrodes when an acustimulation wristband is used. This may be avoided by switching wrists. Acustimulation devices should only be used on the designated area. People with pacemakers are cautioned to avoid placing acustimulation devices on the chest or near the pacemaker because of the possibility of electrical interference. Acustimulation devices should not be used when the cause of nausea and vomiting is unknown. Medical attention should be sought to confirm whether use of an acustimulation device is appropriate. Acustimulation devices should be kept out of the reach of children.

• Asian body work / shiatsu / tuina / acupressure: With proper training, self-administered acupressure and acupressure performed by an experienced therapist appear to be generally safe. No serious long-term complications have been currently reported in the available scientific literature. Forceful acupressure may cause bruising.

• Auriculotherapy: Caution is advised with using auriculotherapy in pregnant women. Acupuncture somatotopic systems strictly prohibit the needling of some points in pregnant women because they theoretically move what are considered "vital essences" and also might induce a miscarriage. Some patients may become lightheaded during auriculotherapy treatment.

• Cupping and moxibustion: Adverse events reported in the available scientific literature from cupping and moxibustion are rare. Cupping commonly leaves a temporary bruising of the skin, which disappears on its own with time. For both cupping and moxibustion, precautions and contraindications are often based on tradition, clinical experience, and theory rather than controlled research. The following uses are mentioned in the literature as to be avoided: the abdomen/sacral area during pregnancy, contraindicated acupuncture points, during high fever, during convulsions or cramps, over allergic skin conditions or ulcerated sores, over an inflamed organ, over inflamed areas in general, in patients with cardiac disease and/or aneurysms, in patients with extreme fatigue and/or anemia, in patients who have just finished exercising or in patients who have just taken a hot bath or shower. It has also been suggested to: avoid sliding cups over the spine, moles, or other skin abnormalities; use caution with patients with neuropathy; avoid the face, head, nipples and genitals, skin adhesions, and points where needling is contraindicated for the individual patient; avoid in patients with any kind of "heat syndrome" according to acupuncture theory, such as in patients with strong heat signs (high fever, etc.); avoid use on or near inflamed and/or red areas of the body; avoid use in patients with diabetic neuropathy or in any situation where the patient may not respond to the sensations of heat. Patients are advised not to bathe or shower for up to 24 hours after a moxibustion treatment. The abdominal area and the lower back during pregnancy are traditionally avoided in both cupping and moxibustion practice out of concern for adversely impacting the uterus or fetus although there are no available published reports of related adverse effects.

• Electroacupuncture: Electrostimulation acupuncture should be avoided in pregnant women (theoretical), in patients with a history of cardiac disorders, including those persons with an arrhythmia or a pacemaker due to the risk of arrhythmia or interference with pacemaker functioning.

• Energy-based bodywork / polarity: Serious adverse effects have not been reported in the available scientific literature. Polarity is not recommended as the sole treatment approach for potentially serious medical conditions, such as a potentially deadly allergic reactions or a heart attack.

• Macrobiotic diet / macrobiotics: Numerous studies indicate that a macrobiotic diet may lead to a variety of nutrient deficiencies. Reasons for these deficiencies include the unavailability of nutrients in the food being consumed, their destruction during preparation of the food, their degradation over time from when the food is harvested to when it is consumed, or the delivery of the nutrient in a form the person cannot digest or absorb. Children and pregnant/lactating women are at particular risk for deficiencies related to a macrobiotic diet. Specific deficiencies which have been reported include calcium, cobalamin (vitamin B-12), dietary fat, iron, magnesium, protein, riboflavin (vitamin B-2), vitamin D, and zinc deficiencies. Related health problems due to nutrient deficiency that have been observed include anemia, growth retardation or growth stagnation in infants and children, low birth weight, low energy, low bone mass, rickets, and scurvy.

• Qi gong / Chi kung: Qi gong is generally considered to be safe in most people when learned from a qualified instructor. In theory, underlying psychiatric disorders may worsen with unsupervised internal Qi gong practice. An allergic skin reaction was reported in one group of Qi gong students, but the cause was not clear. In cases of potentially serious conditions, Qi gong should not be used as the only treatment instead of more proven therapies and should not delay the time it takes to see an appropriate healthcare provider.

• Tai chi / taiji: Adverse effects of tai chi are rarely reported and may include sore muscles or sprains. Tai chi should be avoided by people with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Advancing too quickly while studying tai chi may increase the risk of injury. Tai chi instructors sometimes recommend that practice be avoided during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of chi (qi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Individuals should consult a qualified healthcare professional if they experience dizziness, shortness of breath, chest pain, headache, or severe pain while practicing tai chi.

Author Information

• This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

1. Center for Daoist Studies. www.daoistcenter.org.

2. Centers for Disease Control and Prevention. www.cdc.gov.

3. Energy Medicine Institute. www.energymed.org.

4. Internet Sacred Text Archive. www.sacred-texts.com.

5. Jade Purity. www.daozang.com.

6. National Institutes of Health. www.nih.gov.

7. True Tao. www.taoism.net.

8. World Health Organization. who.int/en.