Energy Medicine: Exploring the Scientific Basis
By Yoon Hang "John" Kim, MD, MPH, FAAMA, and Dorothy Carey, RN, MEd. Dr. Kim is Director of Georgia Integrative Medicine in Tyrone, GA; Ms. Carey is an intern at Georgia Integrative Medicine; they report no financial relationship to this field of study.
Energy medicine is one of five domains of "complementary and alternative medicine" identified by the National Center for Complementary and Alternative Medicine (NCCAM).1 Energy medicine disciplines may vary widely in philosophy, approach, and origin; however, they share a common view that the body, in addition to physical structures and biochemical reactions, also consists of a complex system of subtle energy.
The most common terminology used today for the subtle energy in the context of an integrative medical setting is the Chinese word Qi. Eisenberg describes Qi as "that which differentiates life from death, animate from inanimate. To live is to have Qi in every part of your body. To die is to be a body without Qi."2
There are two types of energy medicine. The first type involves the use of Qi and is commonly referred to as the practice of energy medicine. To date, the study of Qi has failed to yield a reliable measurement and consistent characterization. For this reason, the topic of energy medicine has been controversial.3 The second type is less controversial, because of the use of measurable energy applied for diagnostic and therapeutic purposes. The Table below summarizes the well-accepted uses of energy-based diagnostic and therapeutic tools.
In addition to well-accepted uses of energy medicine, there are many innovative explorations of the therapeutic value of measurable energies such as mechanic vibrations and electromagnetic forces, including visible light, magnetism, monochromatic radiation (such as laser beams), and rays from other parts of the electromagnetic spectrum. They involve the use of specific, measurable wavelengths and frequencies to treat specific conditions.4
The use of energy to stimulate acupuncture points is well established in the practice of traditional Chinese medicine; moxibustion stimulates acupuncture points with heat by burning the mugwort plant. There are many review articles summarizing the findings of studies that demonstrate the effectiveness of electric acupuncture for treatment of pain and depression.5,6 The use of magnetic field for treating musculoskeletal symptoms is more controversial.7 Thus far, there have been two systematic reviews by the Cochrane Library that found no evidence that electromagnetic therapy was useful in healing pressure ulcers or venous stasis ulcers.8,9
Scientific Basis of Qi
The commonality of many energy medicine disciplines is the tenet that subtle energy permeates and flows through all living things, continually circulating within and throughout the body in a complex pattern of flow of energy; this energy flow extends beyond the body, thereby creating an individual's energy field.10 Practitioners of energy medicine believe that illness results from disturbances of Qi.11 Practitioners also believe that they are able to effect changes in the physical body and influence health through their modulation of Qi.
An example of a comprehensive health care system that revolved around the concept of subtle energy is traditional Chinese medicine with many modalities such as acupuncture, herbs, moxibustion, cupping, acupressure, and Qi Gong. In fact, the concept of Qi permeated and influenced the development of the Chinese culture, affecting all aspects of life including art, medicine, sports, and culinary arts.
Historically, there has been reluctance in the scientific and medical communities to acknowledge energy medicine as a valid area of study. Despite professional skepticism, energy medicine is gaining popularity in the United States. A recent National Center for Health Statistics survey indicated that approximately 1% of the participants had used reiki, 0.5% had used Qi Gong, and 4.6% had used healing ritual.12
Influenced by the growing popularity of energy medicine, there are increasing indications for inquisitiveness from the scientific community as well as the medical community. For example, the NIH National Center for Complementary and Alternative Medicine awarded funding for the Center for Frontier Medicine in Biofield Science at the University of Arizona in 2004.13 The stated mission of the center is to facilitate and to integrate research on the effects of low-energy fields.
Characterization of Qi
Examples of efforts to document physical properties of Qi include Kirlian photography, aura imaging, and gas discharge visualizations.14 In addition, an extremely sensitive magnetometer called a superconducting quantum interference device has been used to measure frequency-pulsing biomagnetic fields originating from the hands of therapeutic touch practitioners during therapy.15 In one study, a simple magnetometer measured and quantified similar frequency-pulsing biomagnetic fields from the hands of mediators and practitioners of yoga and Qi Gong. These fields were 1,000 times greater than the strongest human biomagnetic field.16 There are additional data demonstrating other energy frequencies being emitted including infrared radiation.17 However, studies demonstrate that there is a poor repeatability in terms of specific frequencies and other outcome measures with the same practitioner, and there is a poor repeatability among different practitioners.18
Although the full significance of these observations in relationship to healing is not clear at this time, these efforts to characterize Qi bring us one step closer to elucidating the mechanism. The NIH Consensus Statement on acupuncture in 1997 regarding Qi stated that "concepts such as Qi are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture."19 The scientific method depends on the reliability or repeatability of an event and the ability to generalize an observation into a predictable pattern. The fact that both are not possible with the phenomenon of Qi energy conflicts with the scientific method.
Energy Medicine as a Therapeutic Intervention
There are many examples involving Qi including:
- Therapeutic and healing touch
- External Qi Gong
There is a much more exhaustive list available, but these three modalities have the most clinical research available for evaluation.
Therapeutic and Healing Touch
Most clinical trials have been performed in the field of therapeutic touch (TT). TT is a contemporary healing modality drawn from ancient practices developed by Dora Kunz and Dolores Krieger, RN, PhD.20
In 1998, Emily Rosa, at 11 years of age, became the youngest person to have a paper accepted by the Journal of the American Medical Association for her study of TT.3 Her study tested the abilities of 21 TT practitioners to detect the aura they claim surrounds everyone. The practitioners stood on one side of a cardboard screen, while Emily stood on the other. The practitioners placed their hands through holes in the screen. Emily then flipped a coin to determine which of the practitioner's hands she would place hers near (without, of course, touching the hand). The practitioners were to indicate if they could sense her Qi, and where her hand was. Although all of the participants had asserted that they would be able to do this, the actual results did not support their assertions. After repeated trials, the practitioners had succeeded in locating her hand at a rate not significantly different from chance. They were right 44% of the time, slightly worse than chance.
Meehan conducted much of the early research on TT and concluded that "TT does not have a significant direct effect on postoperative pain and does not potentiate the short-term effect of narcotics."21 A Cochrane systematic review of TT for healing acute wounds found no evidence of benefit.22 Another Cochrane review of TT for anxiety disorders found no randomized controlled studies in the area.23 Two meta-analyses found some moderate benefits from TT, but were highly critical of the quality of the research.24,25 In reviewing the studies, there appeared to be a reduction of anxiety arising from situational stress. However, this was not one of the criteria of the meta-analyses.
A recent randomized controlled trial evaluated the efficacy of healing touch (HT) in coronary artery bypass surgery.26 No significant decrease in the use of pain medication, anti-emetic medication, or incidence of atrial fibrillation was observed. However, all HT patients showed a greater decrease in anxiety scores and there was a significant difference in length of stay when the HT outpatient group was compared to the visitor and control groups. Given the current focus on cutting the cost of medical care, length of stay should be investigated as an outcome measure in future studies.
Reiki is another popular energy medicine technique widely used in the United States.27 Reiki was developed in 1922 by Mikao Usui. Practitioners use a technique similar to the laying-on of hands, which they say channels Qi through their palms. Usui claimed to receive the ability of Qi without energy depletion.28 In 2008, Lee published the findings of a systematic review of the effects of reiki in clinical practice.29 Nine randomized controlled trials met the inclusion criteria. Lee concluded that most trials suffered from methodological flaws and that there is insufficient evidence to evaluate the effectiveness of using reiki for clinical conditions.
External Qi Gong
External Qi Gong is considered one of the four foundational healing modalities in traditional Chinese medicine.30 As such, external Qi Gong has enjoyed social validity where Chinese medicine is widely practiced. External Qi Gong refers to a Qi Gong practitioner emitting Qi for therapeutic purposes.31 The first step to becoming a Qi Gong practitioner is to master internal Qi Gong by practicing Qi Gong exercises. The origin of internal Qi Gong is credited to a master Chinese physician Hwa Tuo who created Five Animal Frolics Qi Gong more than 2,000 years ago. Today, there are many styles of Qi Gong, including Tai Chi, a specialized form of internal Qi Gong that focuses on developing mindfulness, balance, and combat strategies. Health benefits of Tai Chi are well documented.32
In 2007, Lee et al published the findings of a systematic review of external Qi Gong for pain conditions.33 Five randomized controlled trials were found. All of the randomized controlled trials demonstrated greater pain reduction with external Qi Gong compared with control groups. The authors concluded that the effectiveness of external Qi Gong for treating pain was encouraging and warrants further study.
The challenges of performing energy medicine research are tremendous. The lack of reliable characterization of Qi makes it impossible to standardize treatments. Despite the challenges, the amount of research both in the basic sciences and clinical trials involving energy medicine has increased.
There is also a concern that randomized controlled trial may not be the best way to explore a phenomenon that is poorly understood. The randomized controlled trial is an excellent method to test if one independent variable has a causal effect on an outcome otherwise referred to as a dependent variable.
In the absence of a thorough understanding from foundational research, it is easy to ask the wrong question, especially if there is a subtle, but potent effect. For example, it is well documented that therapeutic touch reduces anxiety levels of patients compared to controls even in the absence of physical effects.34-36 MacIntyre's study demonstrating that TT decreased anxiety in hospitalized patients, which lead to fewer days of hospitalization, is an example of subtle benefit resulting in more substantial benefit.31
Qi Gong showed a positive result in reducing pain compared to controls.33 This suggests a possibility that external Qi Gong may have more physical effects. The process of training external Qi Gong through extensive practice and achieving mastery of internal Qi Gong is different from TT and reiki. Years of training internal Qi Gong exercises may potentiate the development of Qi.
This idea that the practice of Qi Gong exercises can develop external Qi is supported by one of the theories involving piezoelectricity. Piezoelectricity is the ability of some materials, notably crystals and certain ceramics, to generate an electric potential in response to applied mechanical stress.37 Bone, connective tissues, and blood vessels possess piezoelectric properties and interconnect every part of the body.38 It has been proposed that fascia can be compared with a complex, stretchy network that is constantly releasing and circulating subtle charges. Qi Gong exercises may increase internal coherence of such a network and may result in increase of amplitude. However, these ideas have not yet been tested.
Despite the lack of definitive mechanism and evidence, many energy medicine modalities are gaining popularity. There is positive evidence that external Qi Gong can reduce pain. The evidence regarding therapeutic touch is less substantive but may have a supportive effect in hospitalized patients. Future studies including shortened hospital stay, quality of life, and other outcomes may yield better understanding. There is not enough evidence to evaluate reiki as a healing modality at this time.
Empowerment has been a powerful motivating force behind the rise of CAM.39 Choices should be made to access services based on patients' belief systems. Those patients choosing to do so should seek an experienced practitioner with a good reputation.
1. National Institutes of Health. Energy medicine: An overview. Available at: http://nccam.nih.gov/health/backgrounds/energymed.htm. Accessed Oct. 7, 2008.
2. Eisenberg D, Writ TL. Encounters with Qi: Exploring Chinese Medicine. New York: Penguin Books; 1987.
3. Rosa L, et al. A close look at therapeutic touch. JAMA 1998;279:1005-1010.
4. Vallbona C, Richards T. Evolution of magnetic therapy from alternative to traditional medicine. Phys Med Rehabil Clin North Am 1999;10:729-754.
5. Kim YH, Bowers J. Efficacy of acupuncture for treating depression. Altern Ther Women's Health 2007;9:49-53.
6. Kim YH. Efficacy of acupuncture for treating back pain. Altern Med Alert 2004;7:73-77.
7. Kolasinski SL. Magnets for musculoskeletal symptoms. Altern Med Alert 2005;8:53-55.
8. Olyaee Manesh A, et al. Electromagnetic therapy for treating pressure ulcers. Cochrane Database Syst Rev 2006;(2):CD002930.
9. Ravaghi H, et al. Electromagnetic therapy for treating venous leg ulcers. Cochrane Database Syst Rev 2006;(2):CD002933.
10. National Institutes of Health. Alternative Medicine: Expanding Medical HorizonsA Report to the National Institutes of Health on Alternative Medical Systems and Practices in the United States. Washington, DC: U.S. Government Printing Office; 1994.
11. Chen KW, Turner FD. A case study of simultaneous recovery from multiple physical symptoms with medical qigong therapy. J Altern Complement Med 2004;10:159-162.
12. Barnes P, et al. Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data Report #343; 2004.
13. NCCAM-funded Research for FY 2004. Available at: http://nccam.nih.gov/research/extramural/awards/2004/. Accessed Oct. 7, 2008.
14. Oschman JL. Energy Medicine: The Scientific Basis of Bioenergy Therapies. Philadelphia, PA: Churchill Livingstone; 2000.
15. Zimmerman J. Laying on of hands and healing and therapeutic touch: A testable theory. BEMI Currents, Journal of the BioElectroMagnetics Institute 1990;2:8-17.
16. Seto A, et al. Detection of extraordinary large biomagnetic field strength from human hand during external Qi emission. Acupunct Electrother Res 1992;17:75-94.
17. Lu Z. Scientific Qi Gong Exploration: The Wonders and Mysteries of Qi. Malvern, PA: Amber Leaf Press; 1997.
18. Wang Z, et al. Preliminary study of the relationship between qigong and energy metabolism. Beijing, China: 1st World Conference of Academic Exchange of Medicine and Qigong; 1988:58.
19. Acupuncture: National Institutes of Health Consensus Development Conference Statement. Bethesda, MD: National Institutes of Health; 1997.
20. Feng L, et al. Effect of emitted qi on the immune functions of mice. Beijing, China: 1st World Conference of Academic Exchange of Medicine and Qigong; 1988:4.
21. Cao X, et al. Antitumor meiosis activity of emitted qi in tumor bearing mice. Beijing, China: 1st World Conference of Academic Exchange of Medicine and Qigong; 1988:50.
22. Higuchi et al. Immune changes during qigong therapy. J Int Soc Life Information Sci 1999;17:297-300.
23. Yan X, et al. External Qi of Yan Xin Qigong differentially regulates the Akt and extracellular signal-regulated kinase pathways and is cytotoxic to cancer cells but not to normal cells. Int J Biochem Cell Biol 2006;38:2102-2113.
24. Yan X, et al. External Qi of Yan Xin Qigong induces G2/M arrest and apoptosis of androgen-independent prostate cancer cells by inhibiting Akt and NF-kappa B pathways. Mol Cell Biochem 2008;310:227-234.
25. Astin JA, et al. The efficacy of "distance healing": A systematic review of randomized trials. Ann Intern Med 2000;132:903-910.
26. Meehan TC. Therapeutic touch as a nursing intervention. J Adv Nurs 1998;28:117-125.
27. O'Mathúna DP, Ashford RL. Therapeutic touch for healing acute wounds. Cochrane Database Syst Rev 2003;(4):CD002766.
28. Robinson J, et al. Therapeutic touch for anxiety disorders. Cochrane Database Syst Rev 2007;(3)CD006240.
29. Peter RM. The effectiveness of therapeutic touch: A meta-analytic review. Nurs Sci Quart 1999;12:52-61.
30. Winstead-Fry P, Kijek J. An integrative review and meta-analysis of therapeutic touch research. Altern Ther Health Med 1999;5:58-67.
31. MacIntyre B. The efficacy of healing touch in coronary artery bypass surgery recovery: A randomized clinical trial. Altern Ther Health Med 2008;14:24-32.
32. Miles P. If there is any significant experience with using Reiki in the hospital or ER setting and if there is any literature to support this use? Explore (NY) 2005;1:414.
33. Lee MS, et al. External qigong for pain conditions: A systematic review of randomized clinical trials. J Pain 2007;8:827-831.
34. National Center for Complementary and Alternative Medicine. An Introduction to Reiki. Available at: http://nccam.nih.gov/health/reiki/. Accessed Oct. 7, 2008.
35. Lee MS, et al. Effects of reiki in clinical practice: A systematic review of randomised clinical trials. Int J Clin Pract 2008;62:947-954.
36. Maciocia G. The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. London: Churchill Livingstone; 1989.
37. Ni M. The Essential Text of Chinese Health and HealingThe Yellow Emperor's Classic of Medicine. Boston: Shambala; 1995.
38. Kim YH, Bowers J. Health benefits of tai chi. Altern Ther Women's Health 2008:10:25-29.
39. Heidt P. Effect of therapeutic touch on anxiety level of hospitalized patients. Nurs Res 1981;30:32-37.