Talk:Qigong/Archive 3

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archiving

Hi. I noticed that there is no auto-archiving set up on this page; there are several bots that archive old discussions and this page is going to need some bot attention to clean up. Somebody has manually archived older discussions and so I am going to try set up a bot to build on top of that. My efforts may fail and I may need to unarchive the old discussions and then set the bot to start afresh. So you may see some churn in old discussions if I need to do that. Jytdog (talk) 11:07, 19 February 2014 (UTC)

I will take CJ at her word that she is gone, so I have archived the sprawl that she generated, into Archive 2. (not deleted; archived) Jytdog (talk) 16:37, 19 February 2014 (UTC)

Health-related content based on Jahnke source

Content in the article:

A 2010 literature review of qigong and tai chi exercises found positive results for qigong and tai chi in nine categories, including bone density, cardiopulmonary effects, physical function, falls and related risk factors, quality of life, self efficacy, patient reported outcomes, psychological symptoms, and immune function and inflammation. Studies that compared qigong and tai chi with other physical exercises found similar effects, and greatest effects were found in studies that compared qigong and tai chi to effects in low activity or inactive participants. Unlike the above systematic reviews, this study did not assess for the quality of the underlying trials.(citing Jahnke)

Many claims have been made that qigong can benefit or ameliorate mental health conditions, including improved mood, decreased stress reaction, and decreased anxiety and depression.(citing Jahnke) Most medical studies have only examined psychological factors as secondary goals, however various studies have shown significant benefits such as decrease in cortisol levels, a chemical hormone produced by the body to manage stress.(citing Jahnke)

As we discussed above, the Jaknke source is suboptimal because it is not a critical review. It was cited 4 times in the article. 3 of them were general statements about what kinds of studies have been done and the extent of studies. Just one of them was supporting a health claim. I removed that content and the Jahnke ref in this dif with edit note: "removing the one use of Jahnke out of the 4 we had, that makes a health claim. The other 3 uses are to support general statements (e.g. what indications have been studied) and can stay)". User:Cjrhoads reverted in this dif with edit note "Jytdog, would you please be so kind as to discuss proposed changes on the talk page?". I re-reverted in this dif with edit note "as we discussed on your talk page, you should not be directly editing the article". And I have now opened up this discussion. Jytdog (talk) 23:03, 16 February 2014 (UTC)

Indeed Jahnke et al. 2011 is a "comprehensive review" of RCTs from 1993-2007, and not a systematic review following PRISMA, and it is published in a relatively minor peer-reviewed journal. It has value, within limits, for scholarly and scientific understanding. I will comment further about this in the future as appropriate. TheProfessor (talk) 10:12, 17 February 2014 (UTC)
I just want to add some substance from MEDRS here. In an article that is being contested as this one is, all sides should bring the best resources they can to support content proposals. The section WP:MEDASSESS is the relevant one here. It says: "Knowing the quality of the evidence helps editors distinguish between minority and majority viewpoints, determine due weight, and identify information that will be accepted as evidence-based medicine. In general, editors should rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence, such as case reports, or non-evidence, such as anecdotes or conventional wisdom. The medical guidelines or position statements produced by nationally or internationally recognised expert bodies often contain an assessment of the evidence as part of the report. ....The best evidence comes primarily from meta-analyses of randomized controlled trials (RCTs). Systematic reviews of bodies of literature of overall good quality and consistency addressing the specific recommendation have less reliability when they include non-randomized studies." (emphasis added) Jahnke is clearly a comprehensive review. What is troubling about it, is that they do not analyze the quality of the studies that they review - this is a key factor of any systematic review and is one of the key differences between it and the Lee source from the same year. So I do not think we should rely on it for health claims. For content about what is going on, research wise, great. This is not cut and dry, and I would be very willing to bring this to the MEDRS talk board if folks here really believe that the use Jahnke to support health content is justified under MEDRS. But before I do, I would be interested in hearing arguments, based on what MEDRS actually says (and the spirit of MEDRS, which is that we base health content on the best sources we can find so that we provide the public with reliable information), about why we should rely on it for health claims. Thanks. Jytdog (talk) 13:44, 17 February 2014 (UTC)
While discussion is pending, I have restored the content making a health claim based on Jahnke. If there is no discussion after a reasonable amount of time, I will re-delete it. Jytdog (talk) 19:38, 17 February 2014 (UTC)
Thanks, Jytdog. I'm not sure when or if I'll get to this, nor how important the effort would be at this stage. Yes, it didn't feel right to delete this in the midst of discussion. I am truly trying not to "be on a side", but rather to understand where each person is coming from, to learn, and to do my best. I did appreciate when Roxy the dog emphasized "sources, sources, sources", and of course the best sources we have. And I don't want to be hasty with respect to this deletion, because I did read it thoroughly in the past, and it was carefully and earnestly done, and there are many jewels, though certainly in the rough. And the associated writing, with whatever improvements are needed, may still be appropriate in another part of the article. TheProfessor (talk) 03:13, 18 February 2014 (UTC)
Thanks for replying. I added the paragraph from our article that is sourced from Jahnke above. To be clear, what I am proposing is that we remove that paragraph, because the Jahnke source is not a systematic review and thus is not a good source for health content, especially when there are other reviews that a) are as recent; b) are systematic and c) come to different conclusions than Jahnke, exactly because they are systematic while Jahnke is not. That is how we use sources under MEDRS. I appreciate your desire to take some time and think and have no problem with that.Jytdog (talk) 09:23, 18 February 2014 (UTC)
I believe the paragraph about Jahnke's study adds value and should remain. CJ (talk) 14:18, 18 February 2014 (UTC)
Please state the basis under MEDRS. Also, are you also saying that the health-related content currently supported by Jahnke should remain? thanks. Jytdog (talk) 15:00, 18 February 2014 (UTC)
As a comprehensive review, this is the best source for addressing certain medical questions, like about how many RTCs have been conducted, what are their findings, what medical conditions have positive findings, and can we treat qigong and tai chi studies as a group. I do not know of an independent assessment of its value. Yes, I think there is a basis under MEDRS, with qualifications but care we don't interpret with OR. TheProfessor (talk) 17:49, 19 February 2014 (UTC)
I propose that the paragraph be used to provide background, but with clear qualification that the systematic reviews show part of the data are poor quality. The systematic reviews are narrower in scope, and do not examine the breadth of studies performed, nor the details of findings needed for exploratory analyses. TheProfessor (talk) 17:49, 19 February 2014 (UTC)
Note that "Unlike the above systematic reviews, this study did not assess for the quality of the underlying trials." starts to assess and interpret (OR). It would be better to just cite the systematic reviews as finding that many of the same RCTs were found to be of poor quality. TheProfessor (talk) 17:54, 19 February 2014 (UTC)
Note - I added the mental health section above, currently supported only by Jahnke. I intend to look for systematic reviews to use for this section and to replace Jahnke as a source there, and to update the content based on whatever superior sources say. Jytdog (talk) 12:39, 19 February 2014 (UTC)
Yes we need source(s) for mental health section. Jahnke is it for now. TheProfessor (talk) 18:09, 19 February 2014 (UTC)
We have these sources concerning mental health:
Abstract: Purpose. An emerging body of evidence has shown the therapeutic effect of both mindful and non-mindful physical exercises on the treatment of depression. The purpose of this study is to examine the effectiveness of mindful and non-mindful physical exercises as an intervention in managing depression or depressive symptoms based on a systematic literature review. Methods. Our review was conducted among five electronic databases to identify randomized controlled trials (RCTs), which tested the effects of mindful or/and non-mindful physical exercises on depression. Studies were classified according to the baseline depression status of participants and its relation to allocation concealment, blinding at outcome assessment, follow-up, and whether intention to treat analysis was employed. Results. The results based on 12 RCTs indicated that both the mindful and non-mindful physical exercises were effective in their short-term effect in reducing depression levels or depressive symptoms. However, most of studies had methodological problems that only small sample size was used, and the maintenance effects of physical exercise were not reported. Specific comparisons between RCTs on mindful and non-mindful exercises were not performed because of the limitations on the designs. Conclusions. We recommend that more well-controlled studies have to be conducted in the future to address the short- and long-term effects of physical exercise on alleviating depression. Efforts should be focused on unveiling the differential effects of mindful and non-mindful exercises on depression and the underlying mechanisms of their therapeutic action. © 2008 The British Psychological Society. ISSN 0144-6657. 2012 Impact Factor: 2.333. 2012 SCImago Journal Rankings: 1.108
  • Oh B et al. Effects of qigong on depression: a systemic review. Evid Based Complement Alternat Med. 2013;2013:134737. PMID 23533461 Concluding statement of abstract: "While the evidence suggests the potential effects of Qigong in the treatment of depression, the review of the literature shows inconclusive results. Further research using rigorous study designs is necessary to investigate the effectiveness of Qigong in depression."
TheProfessor (talk) 19:35, 19 February 2014 (UTC)

Research Lead - Let's Move Forward

The process above does not appear to be converging on a satisfactory conclusion, so I prefer to start fresh. Let's roll up our sleeves, resurrect and revitalize the effort, and do what is necessary to produce a meaningful improvement in a timely manner. Senior editors, please help provide leadership and guidance to move this forward. Everybody, please consider the following text:

Research concerning qigong has been conducted with respect to a wide range of medical conditions, including cancer, pain, diabetes, Parkinson’s disease, hypertension, and general chronic conditions. While many individual clinical studies report positive effects, the quality of most research is poor, and thus "it would be unwise to draw firm conclusions at this stage".

Why?

  • The term “research” at the beginning reads better than "clinical trials" and establishes the general topic of the lead paragraph.
  • The list of conditions examined in meta-analysis is specific and informative of what conditions were in the systematic reviews (strong content for Wikipedia, certainly not a "laundry list"); whereas "various medical conditions” is vague and poor content for Wikipedia.
  • That many clinical studies “report positive effects” is a key point and relevant in Wikipedia, but only with clear qualification that the research is poor.
  • That the quality of the research is poor is key, and perhaps could be elaborated on to explain why.
  • Finally and importantly, "it would be unwise to draw firm conclusions at this stage” is the conclusion to emphasize.

Note:

  • The conclusion "this area merits further rigorous research” is not very informative or appropriate for Wikipedia and thus should be left out.
  • To be complete, the lead could explain why research was poor, "typically because of small sample size and lack of proper control group”, which again comes directly from the Lee et al. 2011 Overview of Systematic Reviews.
  • The conditions "fibromyalgia, anxiety, depression, and well-being" have been covered in systematic reviews published since the Lee et al. 2011 Overview of Systematic Reviews, and perhaps should be added back in to be truly up to date.

The new lead would clearly be an improvement over the existing lead. It is clear, concise, informative, and follows Wikipedia standards (WP:MEDRS, WP:NPOV, WP:VER, WP:OR…). And it steers a clear middle ground that incorporates the discussion above. How could we do better at this stage? If anybody has other views, please be specific about how the lead could be improved with specific alternative wording. If you are not sure about Wikipedia editing practices, please read up on them, and discuss as needed in other appropriate discussion places, so we can keep this discussion focused and productive. Please let's all keep this civil and constructive. TheProfessor (talk) 02:58, 18 February 2014 (UTC)

Hi Professor. I am assuming this is a continuation of the discussion about replacing the sentence in the Lead of the article. If I am wrong, I apologize for that. Thank you for presenting this, with clear arguments. One of the things that has been difficult about this discussion, that Yobol has mentioned and that I will now raise at more length.... As per WP:LEAD, the Lead of the article summarizes what is in the body of the article; nothing should be in the lead that is not in the body. Currently in the body of the article, the following indications are discussed at some length: hypertension; pain, "cancer treatment" (existing text is not clear as to whether qigong is meant to treat the cancer per se or improve QOL for cancer patients and we should fix this); "mental health conditions" (also broad and vague and should be fixed), and there is the laundry list from Jahnke which I hope we will be able to strike, pending the discussion in the other section. Of the list you propose, there is no discussion in the body of the article on diabetes, Parkinson’s disease, nor general chronic conditions. So those three have no basis for being in the lead. Your last bullet is very good but I would say "should be added to the body of the article". What we should be concentrating on is improving the body of the article and updating the lead as we go. What unfortunately happens too often, especially when inexperienced editors get involved, is that inordinate attention is focused on the lead, especially its spin, and the body of the article -its actual substance - is neglected. All that said, I think it is pretty fussy to include a changing list of indications in the lead, especially when the results for each may well be different. If accepting such a list is what it takes to get consensus, I will yield on that, provided that everything in the list is discussed in the body (not just part of a list there - as per WP:LEAD, weight in the lead should reflect weight in the body). I hear you that including reference to the positive clinical trials is important to you. I am glad you have the qualifier, "While", there, since we need to make it clear that the individual positive reports do not have a lot of meaning. I would like something stronger like "Although" but can live with "While". I would be OK with adding the reasons why the trial designs are poor. Jytdog (talk) 09:14, 18 February 2014 (UTC)
Thanks Jytdog. I agree that in general we should focus on improving the body of the article, and update the lead as we go. First, I would like to reach consensus on the lead and encourage us all that the Wikipedia editing process can actually work. I had hoped that starting with the lead could be a quick win for everybody, and this would encourage activity on improving the body of the article. Yes, the list in the lead should include what is actually in the body of the article, weighted appropriately. Perhaps it is fussy to keep changing the list, but it does make for a better article if kept up to date; and the lead is what people see first, so it should be clear, concise, and informative. The list is important up front. Let's see what others say before deciding whether to add the reasons why the trial designs are poor. I thought there was an objection to this, for some reason. Also, let's see how others respond before we tinker with details like "while" versus "although". I am glad we are making progress. The straw vote seems cumbersome, and I think I'll opt out for now as well. TheProfessor (talk) 13:09, 18 February 2014 (UTC)
I'm all for your wording here. I think it makes sense, and would be a good choice. I would absolutely support it. CJ (talk) 13:17, 18 February 2014 (UTC)
Thanks, CJ.TheProfessor (talk) 20:36, 18 February 2014 (UTC)

OK, I took what we have drafted and blended it with the lead that was in the Medical claims section and ended up here, and I copied that into the Lead of the article as well: "Research concerning qigong has been conducted in a wide range of medical conditions, including hypertension; pain, and cancer treatment. A 2011 systematic review found that although many individual clinical studies report positive effects, claims for effectiveness of qigong are "based mostly on poor quality research. Therefore, it would be unwise to draw firm conclusions...."(cite Lee)" I added reference to the date of the study to make sense of when "this stage" is.Jytdog (talk) 01:35, 19 February 2014 (UTC)

I have removed mention of the results in the individual trials as this is not the conclusion of the source cited, "In conclusion, several systematic reviews of qigong for a wide range of conditions have recently been published. Most of these systematic reviews were not conclusive and all were based on poor quality clinical trials. Given these important caveats, it would be unwise to draw firm conclusions about the effectiveness of qigong. Our overview does, however, suggest that this area merits further rigorous research." I have also removed in text attribution to this one systematic review as ALL systematic reviews have said that the quality of research is poor and no firm conclusions can be made. Citing it to this one study seems to imply other sources disagree; they do not. Yobol (talk) 01:59, 19 February 2014 (UTC)
I have brought the "Claims and Medical Research" section into line with the above improvement by Yobol. --Roxy the dog (resonate) 02:15, 19 February 2014 (UTC)
Thanks, Yobol. I just read Lee again, and you are right. Lee is our best source (most recent, most rigorous - systematic review of systematic reviews) and we have to follow it, and it does not say anything like "many individual clinical studies report positive effects." I was hoping to throw a "positive" bone but we cannot justify it. Thanks for allowing the list in any case - that was bendy of you. Jytdog (talk) 02:41, 19 February 2014 (UTC)

OK, so I think that we all took a good faith effort at revising this part of the article. Here is where things stand as I see it. Our best source is Lee 2011. It does not provide a basis for the kind of "positive" statement that User:Cjrhoads has pushed hard to obtain. Until a source of equal or better quality comes along and replaces Lee (and systematic reviews are published periodically in fields of active research) we are not going to be able to say more than this in the Lead of the article. I don't think it will be productive to continue working on these two sentences until that happens; I intend to respond in future discussions on this content only if they are based carefully on Lee (or its successor), or only if they propose other sources carefully justified under MEDRS. I will probably revert edits to the article that attempt to make this language more positive that are not based carefully on Lee or its successor. I intend to start working on improving the article in other ways. User:Cjrhoads I would appreciate it if you would remove the latest "straw poll" below, to which no one has contributed except to state nonparticipation. You have my permission to delete my comments in it. Professor, would you mind if she deletes yours too? Thanks. Jytdog (talk) 11:03, 19 February 2014 (UTC)

Thanks Yobol and Jytdog. I have a bit of a different take of where we stand. And I'm not convinced we have done due diligence with the lead yet, though I don't want to wear us out in some sort of silly editing war. So let's discuss earnestly and intelligently (don't worry, I'm not pushing an agenda beyond the best possible Wikipedia content).
First, I believe you may be misinterpreting MEDRS. This can be understood as it applies in the context of the specific elements of the research lead. Several points:
1) If I am understanding correctly the "best source" depends upon what question is being asked, and to name a single "best source" does not make sense except with qualifiers. Indeed Lee et al. 2011 is the best source we know of to date for reviewing systematic reviews, though it has not been reviewed beyond the peer-review of a reputable journal. The best source with respect to various aspects of the study of a condition may be the systematic review itself, an individual study covered in the review, or even another source, not necessarily Lee et al. 2011. Let's be frank, Lee et al. is fine as far as it goes, but it clearly is just a short communication, not terribly rich in information, and certainly not the go-to source for all the questions we might need to ask/answer. At this stage, I'm only convinced that we need to reference all Wikipedia medical content carefully with appropriate best sources justified under MEDRS.
2) Relevant questions that are important for the the article need to be agreed upon. Here are some key medical questions that lay people and professionals want to answer by consulting Wikipedia: Is qigong safe? Is qigong effective? What conditions may benefit from qigong, and has this been studied? What are the findings? What is the quality of the research? Is there a scientific consensus about effectiveness, and if not what are the views (mainstream, multiple, minority, alternative...)? Why don't we know more? Will we ever know more? I'm sure you can think of more.
3) Up front we need to write a good lead in to what is actually in the article, along with concise and informative answers to basic questions. A list of conditions studied (and discussed in the article), findings of studies, quality/reliability of research, why we don't know more, and the overall conclusion. The old lead was relatively vague and poor content. We have made a small amount of progress.
4) The lead starts by answering what conditions have been studied. I recommend that we include the "best sources" for each of the listed items (the corresponding systematic reviews) and add to the list as the text in the article body is developed, and keep the list a reasonable length in the future, perhaps choosing the most relevant, representative, or most important, or perhaps aggregated categories, like the original proposal of CJ. By the way, eventually including a category like "longevity" in the list is reasonable category, because it is one of the main categories mentioned over and over in the literature, though it is not an easy question to answer medically, which might be addressed in the body with the "best source" for that question.
5) The answer to whether positive effects have been found is highly relevant. This is answered not, explicitly by Lee et al. 2010, but rather the systematic reviews themselves are the "best sources" in various cases, but other "best sources" also exist. Frankly, the "best source", if you are looking for just one (and please don't clobber me too hard - I really am wearing my best Wikipedia editor hat) would be Jahnke et al. 2010, because it is the "best source" to answer questions that only a comprehensive review can answer; and it goes way beyond the systematic reviews in being rich in referenced data about the articles, like sample sizes, design, findings, and conclusions. And yes, we need to be careful not to be misleading, in that qualification that "the research is poor"
6) The answer to why the research is poor is highly relevant, and certainly should be in Wikipedia, summarized in the lead, and elaborated on in the . The short answer is easy and comes from the favored source Lee et al. 2011: because, and I quote, "the most frequent limitations of the primary studies are small sample size and lack of proper control group". No, this not "cherry picking". It is actually reading and understanding the source. The more detailed answer of why actually requires that we address, experimental design (no I'm not suggesting OR), because this is covered by our other "best sources" the systematic reviews, though I also think there are even "better sources", which makes them "best sources" that address the issue of double blinding, dosing
7)The answer to the question of the overall medical conclusion comes straight from Lee et al. 2011: importantly, "it would be unwise to draw firm conclusions at this stage”. Even for the question of the medical conclusion, it is what we can say based on poor quality systematic reviews, while there really are different opinions, and other sources that could be important to represent according to MEDRS.
Second, I encourage us to turn our focus to rewriting the medical research section, based on key "best source" references. I may be idealistic, but it could help develop rapport, give a good Wikipedia editing experience for newbies (or in-between-ies like me) to learn from senior editors, and actually get something done. True collaboration on the common ground could be productive, if we agree on the scope. Yes, I suspect controversy will arise, but we can be prepared, especially if there is a senior editor good at mediating, and we could start with some core material that we agree is just trying in good faith to get some of the work done. Really, it could be much more fun and productive than edit wars about small details. Let's get a bigger chunk done. Are we able to agree on a simple outline or list, and then develop text based on the "best source" or "best sources"? There is already a good start.
In terms of housekeeping, I do not like clutter, so yes I'm fine with CJ deleting the latest "straw poll", though I would also ask CJ to check first for pithy discussion that we don't want to lose, and that could be summarized somewhere accessible. I'm all for orderliness, but I also want to keep what may be valuable. I'd actually love to see the active discussion threads(s) moved to the end so we can find our place easily (only by agreement). TheProfessor (talk) 16:05, 19 February 2014 (UTC)
Quick note, I believe that User:Cjrhoads is gone, as per this. Jytdog (talk) 16:28, 19 February 2014 (UTC)
Sad, if that is the final word.TheProfessor (talk) 16:55, 19 February 2014 (UTC)
I agree. In my view, she was too busy to engage with how we do things, and expressed that high-handedness perfectly in her last action. The kindest framework I can put on this, is that I think she thought wikipedia would be more like a blog than the rigorous place of scholarship that it is, complete with a framework that the community has built over the years for creating good articles collaboratively. There is a lot to learn - you cannot just sweep in and do what you want. If she had taken the time to engage with the Wikipedia way she could have become a valuable contributor. In any case... I really appreciate where you have been coming from and look forward to working with you. I agree with a lot of what you wrote above, with one big exception. We should take our eyes off the lead for now and concentrate on implementing your great suggestions for working on the body - describing the research that has been done, and how it is has been done, including its limitations, in much more and better detail. Once we have done that, the lead will be pretty brainless to rewrite. But the medical research section in the body is pretty slim now, so there is little more we can say in the lead, than what we already have. Can we focus on the body? And a final note - if you track Lee's work, over the past several years he and his colleagues have done a series of systematic reviews on the research in qigong in various individual indications; the short article sums up all that work, along with the work of others. So it is indeed a really great overview, from the team that may be the best suited team in the world to provide it. But I have used up all my wikipedia time for today - i gotta go do my real work now! I will check in later for sure, but this is my last substantial post til tonight. Thanks again for your thoughtful post above.Jytdog (talk) 17:12, 19 February 2014 (UTC)

:::As part of the Wikipedia community we need to do better at welcoming, communicating, and mentoring. I look at this as a loss of talent and opportunity. The responsibility is shared, and not really just the burden of the newcomer. I myself felt brutalized when I first worked on this article. And my learning curve and productivity would have been much higher in a more supportive atmosphere. Many excellent people are being driven away. I am not talking about fringe or unreasonable people, but people who have much to offer. I don't buy that it just about COI or POV; it is about how we learn to conduct ourselves, listen, communicate, and build something meaningful. We don't have to be on "different sides". I don't even know what "side" I would join... ..oh yes, except the side that creates a safe and supportive environment where one is welcomed and can learn about how to contribute to Wikipedia. We all share the responsibility. TheProfessor (talk) 18:29, 19 February 2014 (UTC)

::::i disagree with you 100%. but this is off topic and I will not discuss this further here (I have written about four additional responses and deleted them before saving them). Way off topic. Jytdog (talk) 18:56, 19 February 2014 (UTC)

Thanks for your encouragement and insights. TheProfessor (talk) 19:55, 19 February 2014 (UTC)

I added references for the list of medical conditions and language for medical conclusions in the Qigong article research lead:

Research concerning qigong has been conducted for a wide range of medical conditions, including hypertension[1], pain[2][3], and cancer treatment[4]. Systematic reviews of clinical trials conclude that the quality of most research is poor, and thus "it would be unwise to draw firm conclusions at this stage".[5]

TheProfessor (talk) 23:47, 19 February 2014 (UTC)

Research impediments - material for the body of the article

Hi professor

In our first interactions you wrote about impediments to quality research: "Yes, I am saying why is relevant, which is part of the substance of the reviews. Explicitly, why includes lack of funding for research, impracticality of double blinding, and difficulty of standardized controls and treatment dosing (frequency, duration, and intensity of treatment). TheProfessor (talk) 16:29, 14 February 2014 (UTC)" You seem to be very well aware of the literature on this. Do you have MEDRS sources on this? That would be super valuable to start building a section discussing this, which would then give us justification to include discussion of it in the Lead. Thanks! btw, just to lay this down, I am especially interested in the 2nd through 4th things in that list - the difficulties in even designing a clinical trial; issues of funding are more of a business question than a scientific one (although of course practically speaking, the science cannot actually happen without money, and i could see lack of the possibility of executing a trial stifling attempts to even design one -- but the more thorny and substantial issues are the scientific ones). I am really curious about why dosing is a problem in trial design for qi gong. This is the part of Wikipedia that I love - getting and reading great sources and building content based on it. Jytdog (talk) 10:44, 20 February 2014 (UTC)

I appreciate you moving forward with a focus on the impediments to quality research. I'm not sure how readily we can back this with MEDRS sources. As a starting point, Lee et al. 2011 emphasizes small sample size and inadequate controls, but frankly I need to go back through the systematic reviews and other sources, and the information may be scattered. TheProfessor (talk) 17:55, 20 February 2014 (UTC)
OK that's a place to start. i will check there. there are some references to this in the Controversies section that i started reading this morning..... thanks!

Lead

Hi professor - please read WP:LEAD. The wikipedia way is: you write the body of the article, then you write a lead that summarizes it. If you update the body, you update the lead. You generally do not need any references in the lead, because all that the lead does, is summarize what is already in the body. You only need refs in the lead, if a) you make some big summarization in the lead that is so general, that somebody challenges it as being OR or not true, or b) if there is some controversial fact you include in the lead (that is backed by reliable sources in the article) that people will be surprised by and challenge the validity of. That is how Wikipedia works. It is batshit crazy to put a reference in the lead for some basic fact and not have that reference used in the body, like you did today. So i reverted it. Please please please let's do things the Wikipedia way. Let's work on the body and then fix the lead. Jytdog (talk) 23:54, 19 February 2014 (UTC)

As you suggested I went back and reread WP:LEAD. I still don't understand why you reverted changes we already discussed. This lead corresponds directly with the existing body, and is what we have been discussing. Only references that were in the body were included in the lead, so I do not understand your comments. Why didn't you object sooner, as part of the discussion? I have said all along that the references would be added. Why did you make changes that Yobol later reverted? And why are you allowing Yobol's recent changes to stand? Yobol, maybe you can help me understand. I am sincerely trying to understand. TheProfessor (talk) 03:04, 20 February 2014 (UTC)
you don't put sources in the lead that are not in the body. i thought i signalled pretty clearly that my preference is that we leave the lead alone for now. sorry for not being more clear about that. I wouldn't have reverted if you had just changed the text as you did (i am really really sick of the lead by now and that was no big deal to me) - it was loading the refs in, that got me. that makes no sense. Jytdog (talk) 04:07, 20 February 2014 (UTC)
Please look back at the body of the article. Only sources from the body are included in the research lead list of medical conditions. As I wrote above (in the Research Lead - Let's Move Forward thread) " I recommend that we include the 'best sources' for each of the listed items (the corresponding systematic reviews)", and thought it was clear that meant referencing each item in the list. WP:LEAD states "the lead section should briefly summarize the most important points covered in an article in such a way that it can stand on its own as a concise version of the article", which to me implies it needs references. I couldn't find anything that says otherwise, but maybe I am missing something. I observe that the rest of the lead is referenced, as are other article leads I have worked on. Unless there is a substantial objection, could you please reinstate my edits? I would like to set a precedent that we can work together, and in particular that my edits are not reverted without cause. I now understand the objection was just an error. Note that I did not do any editing of the article until I thought we had resolution. Yes, let's move on. TheProfessor (talk) 06:18, 20 February 2014 (UTC)
I acknowledge I made an error in what I wrote above! Because you restated the entire citations, I stupidly said these were actually new sources. Of course they are not. (btw, we generally don't restate entire sources this way - instead we use the "named reference" feature for repeated use of a citation, as described here: WP:NAMEDREFS.) Calling them new is entirely my bad - I apologize! As for the rest... the 2nd section of WP:LEAD is called Citations; my original post above was a paraphrase of it. Again the whole idea of the Lead is that it just summarizes what is in the body; what is in the body will be well sourced. As per Citations, there is no requirement that citations be used in the Lead (except for quotes which are jarring without a citation). It just saves everybody time and hassle if you deploy an inline citation in the Lead for material that is likely to be challenged, but that will always be a repetition of a source already used in the body. I do acknowledge that Citations also says that citations are not banned from the Lead. It comes down questions of style and judgement. I rarely pay much attention to the lead and hadn't seen how cluttered this one was with citations. I didn't see anything very likely to be challenged there (with the exception of the thing that provoked all the recent fuss), so I removed all the citations except for that one. Please do tell me if you see anything else in the Lead that is likely to be challenged! Also, in reviewing the Lead I discovered that the definition of qi used in the Lead was not found in the article, and I fixed that. As you can see, I greatly prefer Leads that are uncluttered, and that citations be deployed in the Lead only for controversial matter or quotes. This stance arises from really reflecting on what the Lead is - it is just a summary of the key points of the actual article and should never be considered on its own, and everything in the body will already be well cited. (I don't know if you noticed but when I implemented the language we agreed on, I first put it in the body, and then put it in lead afterwards, so that we had literal support for this controversial summary in the body) Jytdog (talk) 10:13, 20 February 2014 (UTC)
Anyway it is from that position of really reflecting on what the Lead is, that I find this sustained attention on perfecting the lead so baffling -- especially when the related section of the body is so much in need of work. Everybody has limited time, so why we are not spending it on the real underlying unmet need? It is clear that CJ came here with the goal of promoting the health benefits of qigong, and generally I find that people with such promotional motivations try to get their goals met in the lead - they tend to be focused on ensuring that casual readers get the just the right first impression (I think CJ actually said that at one point), and the substance and quality of the actual article are secondary concerns by far. (I haven't work directly with you much so don't yet understand why you are so focused on it - and I mean that, I am making no assumptions - I don't know why you are so focused on it) Focus on the Lead is also something that new and inexperienced editors have; no experienced editor will add, or will allow to be added, matter to the lead that is not already in the body, and experienced editors tend to focus their editing time on adding and updating content in the body of the article, and just update the lead afterwards if the new matter requires it. As I wrote above a few times, I really have no desire to keep discussing the Lead - it is a decent and supported summary of what is in the body. Can we please let it go already? Jytdog (talk) 10:13, 20 February 2014 (UTC)

First, why am I continuing to focus on the lead? Honestly I'd just like to get to a stopping point where my efforts mean something. Thus I published what I thought was agreed upon and faithfully follows Wikipedia guidelines, found myself challenged for no reason, and found myself in discussion that feels off track, and not necessarily convergent on an end point. I think it is reasonable for you to reinstate the edits you reverted based on an error, so we can move on. As I understand, you would rather just move on. I agree that efforts would be better focused on the body. All of this is in the aftermath of a rather wearing frenzy of activity.

Second, in terms of WP:LEAD, yes I understand your point, though in part I have a different view. Yes, "Editors should balance the desire to avoid redundant citations in the lead with the desire to aid readers in locating sources for challengeable material... The necessity for citations in a lead should be determined on a case-by-case basis by editorial consensus. Complex, current, or controversial subjects may require many citations; others, few or none. The presence of citations in the introduction is neither required in every article nor prohibited in any article." I understand you want to avoid redundant citations. My preference would be to use more references rather than less, especially for an article like qigong that can become such a grab bag, and also because of my academic training, which compels me to use a reference the first time a subject is brought up (though I understand the lead is more like an abstract which may not be referenced). At this stage I don't want to do a disservice to the article with piecemeal changes. You are making a point by removing the references in the lead, but please not at the expense of the article. Case and point, the definition of qi in the lead was different from that in the body, and I had noticed this, and even intend to resolve it, ideally by bringing the lead in line with the body, and in line with the Qi article. The latter two definitions you brought forward from the body are not as commonly used and the one in quotes in the lead is more commonly used. In this case it might make sense to leave it alone unless you have time to do the work. This is leading us off track, which of course is your point, as well. TheProfessor (talk) 16:04, 20 February 2014 (UTC)

user:Professor. Responding to your note on my Talk page. I reverted my changes to the lead. I got rid of the duplicate refs you created and I moved the definition of qi that appeared only in the lead, into the body. And yes, the lead of a wikipedia article is very much like a scientific abstract - it is not like the introduction to a manuscript. References are not needed. A wikipedia article is like a scientific manuscript in some ways, but it is very unlike a scientific paper in others; you should not use a scientific ms as a model as it will lead you astray in many ways. This is one of the big challenges for scientists who come edit (especially the reflex of citing primary sources and creating your own syntheses. Anyway, I am not going to edit or comment on the lead anymore; I am going to concentrate on the body. Have a great day!Jytdog (talk) 16:28, 20 February 2014 (UTC)
Thanks! I wish you a great day, as well. TheProfessor (talk) 18:09, 20 February 2014 (UTC)
ah, lovely freedom of movement. now we are working. Jytdog (talk) 18:21, 20 February 2014 (UTC)

References in Chinese

my strong preference would be that we have no refs in Chinese; it is ok to have foreign language refs is there is no english source; is there really no english source for the content currently supported by refs in chinese? i intend to replace them with time. Jytdog (talk) 17:25, 22 February 2014 (UTC)

I agree that where possible it is best to use references in English, given that this is an English Wikipedia article, and certainly wherever good translations or alternatives are available. Editors proficient with Chinese can help evaluate specific sources. Here is a useful Chinese textbook, recently translated to English:
Liu, Tian Jun, and Xiao Mei Qiang (editors). 2013. Chinese Medical Qigong, Third Edition. Singing Dragon, London and Philadelphia.
Contents
Editor's Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
General Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
I. Essential Concepts of CMQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
II. The Academic System of CMQ . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
III. Subjects Related to CMQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
IV. The Study of CMQ. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Part 1 Fundamental Theories
Chapter 1 The Origin of Qigong and the Major Schools
1. The Origin of Qigong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
I. Historical Texts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
II. Medical Texts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
III. Archaeological Discoveries . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2. Major Qigong Traditional Schools . . . . . . . . . . . . . . . . . . . . . . . . . 34
I. Medical Qigong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
II. Daoist Qigong. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
III. Buddhist Qigong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
IV. Confucian Qigong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
V. Martial Arts Qigong. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Chapter 2 Classical Theories. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
1. Theories of Medical Qigong . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
I. Theory of Yin-Yang and the Five Elements . . . . . . . . . . . . . . . . 46
II. Zang-fu (Visceral manifestation) and Meridian theory . . . . . . . 50
III. The Theory of Essence-Qi-Spirit . . . . . . . . . . . . . . . . . . . . . . . 55
2. Theories of Other Qigong Schools . . . . . . . . . . . . . . . . . . . . . . . . . 58
I. Daoist Qigong theory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
II. Buddhist Qigong theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
III. Confucian Qigong theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
IV. Martial Arts Qigong theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Chapter 3 Modern Scientific Research on Qigong . . . . . . . . . . . . . . . . . . 81
1. Summary of Modern Research on Qigong . . . . . . . . . . . . . . . . . . . 81
I. Development of Modern Research on Qigong . . . . . . . . . . . . . . 81
II. Trends and Controversy in Qigong Research . . . . . . . . . . . . . . 86
2. Physiological Effects of Qigong. . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
I. Effects of Qigong on the Respiratory System . . . . . . . . . . . . . . . 90
II. Effect of Qigong on the Cardiovascular System. . . . . . . . . . . . . 93
III. Effects of Qigong on Neuroelectrophysiology . . . . . . . . . . . . . . 97
3. Psychological Effects of Qigong . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
I. Operational Mechanism of Adjusting Mind in Qigong Practice. . 103
II. Psychological Elements of External Qi Therapy . . . . . . . . . . . . 106
I'll post more of the contents later if that would be useful. TheProfessor (talk) 05:15, 26 February 2014 (UTC)

content in Mental Health section on "deviation"

I just deleted the following (ref markup changed): "There are also claims that in some cases, in particular with improper teaching or improper technique, the practice of qigong can result in a mental condition known as Zou huo ru mo (走火入魔) or "qigong deviation" (氣功偏差), which, among other symptoms, can lead to a perception of an uncontrolled flow of qi in the body during or after practice.(ref name="Nancy3"/)(ref name=autogenerated3)Palmer, David A. (2007). "Chapter 6. Controversy and Crisis". Qigong fever: body, science, and utopia in China. Columbia University Press. pp. 158–170. ISBN 0-231-14066-5. {{cite book}}: Cite has empty unknown parameter: |month= (help)(/ref)(ref name=autogenerated2)Ownby, David (2008). Falun Gong and the future of China. Oxford: Oxford University Press. pp. 181–186. ISBN 978-0-19-532905-6.(/ref)" None of these sources are MEDRS compliant. Jytdog (talk) 22:58, 16 February 2014 (UTC)

More references concerning "qigong deviation" are on the Zou huo ru mo page. Those references need to be evaluated for MEDRS compliance. I helped rewrite and reference this quite some time back and may be of help. The topic of "qigong deviation" is part of traditional culture, Chinese medicine, and conventional medicine. Let me know your thoughts of where this material belongs and whether the language is well crafted. It went through various edits with some experienced editors, and I do not recall controversy. I do not have time to work on this now, and need to pace myself. TheProfessor (talk) 01:39, 17 February 2014 (UTC)
thanks for your note! wow i just read the Zou huo ru mo page. holy moly that is a complicated ball of wax. Need to reflect on that. Jytdog (talk) 01:44, 17 February 2014 (UTC)
It is an important concept and should be included. ottawakungfu (talk) 17:49, 17 February 2014 (UTC)
thanks for your note User:Ottawakungfu! What sources can you bring that show that it is "important"? For health matters, "importance" is often determined by how common a disease or condition is, or how severe. Do you have a MEDRS-compliant source the provides its incidence (the risk of getting the disease/condition in a given year) and prevalence (how many people have it at a given time) or something on mortality/morbidity (if you get it, how likely are you to die, or how debilitated are you if you get it)? Something that shows this is important with respect to health? Thanks! Jytdog (talk) 19:54, 17 February 2014 (UTC)
or is the concept important for some other reason - like the use of this label in relation to falun gong? if that is why this is important we can move the discussion out of health and into some other section and remove discussion of things like "symptoms". Jytdog (talk) 20:31, 17 February 2014 (UTC)
Thanks Ottawakungfu and Jytdog. Yes, the concept is import for cultural and historical perspectives (and in relation to Falun Gong). We wouldn't want us to lose potentially valuable and carefully research text. I think there may be some good medical sources on the Zou huo ru mo (medicine) page that also ties this into health and medicine. And we need to restore the Zou huo ru mo (medicine) link in an appropriate location in the qigong article. TheProfessor (talk) 03:35, 18 February 2014 (UTC)
Thanks for replying. I think it is great for this concept to be part of the article and have every intention of putting it back somewhere... I have been reading about this and trying to figure out where it fits. Professor, would you please say more about why you see it as important for cultural and historical perspectives? thanks! Jytdog (talk) 08:19, 18 February 2014 (UTC)
Yes, I am only familiar in a limited way. The term zou huo ru mo (走火入魔) implies that something has gone wrong in one's martial arts training. I am not sure about ancient history, but in recent history there has been a fascinating interplay between culture and medicine with respect to qigong and zou huo ru mo (see Chen 2003, Palmer 2007).
Excerpt from Chen 2003 Breathing Spaces, Qigong, Psychiatry, and Healing in China: "In the post-Mao period, qigong flourished as a highly charismatic form of healing. I argue that the turn toward self-cultivation and alternative healing did not occur in a vacuum. Instead, as the Chinese state shifted from subsidized medicine to for-profit market medicine, qigong masters quickly assembled vast networks, across China and abroad, in response to concerns for health in the new economy. Three central arguments frame this ethnographic study. First, qigong was immensely popular mainly because it met people’s needs to cope with chronic health concerns while promoting a sense of belonging. The transition to a market economy facilitated the widespread interest in qigong as an antidote through self-discipline. Second—less well known by most practitioners, especially outside China—qigong could potentially be harmful to certain individuals. The pathologies associated with the practice became medicalized into a new psychiatric category recognized by professionals. I document the unique ways in which qigong and psychiatry intersected for ordinary practitioners, certain patients, their families, work units, doctors, and bureaucrats. In tracing the transmission and travel of these forms of knowledge over a decade, my main focus is on the compelling search for healing found in both arenas. State officials initially promoted qigong because it was viewed as effective and uniquely Chinese. However, this shifted to regulation when certain masters were considered to be promoting pseudoscience. The boom period of widespread interest was curtailed by the active involvement of the state bureaucracy. Finally, the transnational travel of qigong masters and global followings disrupt any notions that qigong is solely a local Chinese practice unchanged by time."
Excerpt for Palmer 2007 Qigong Fever, Body, Science, and Utopia in China, pp 130-134: "Victims of zouhuo rumo were often taken by their families to the outpatient clinics or to psychiatric hospitals, some of which opened special clinics for treating what Chinese psychiatrists called 'qigong deviation' (qigong piancha). A minority were diagnosed with schizophrenia or other psychotic disorders, and admitted to inpatient wards. These included patients who refused to eat or drink, who had delusions of grandeur, who thought themselves invisible and omniscient, or the reincarnations of the Jade Emperor etc. Zhang Tongling, a psychiatrist at the Beijing University of Medical Sciences, opened a clinic for qigong deviation in 1989 where, over the next six years, she treated about four hundred patients. In her analysis of the cases 5 she concluded that qigong could either exacerbate pre-existing mental disorders or trigger psychotic symptoms for the first time among vulnerable individuals with an obsessive interest in qigong. Psychiatric research on qigong deviation led to the creation of a new category of mental illness, 'qigong psychotic reaction', classified as a 'culture-bound syndrome' in the Diagnostic and Statistical Manual of Mental Disorders, the main reference for the international psychiatric profession, which defined the disorder as 'an acute, time-limited episode characterised by dissociative, paranoid, or other psychotic or non-psychotic symptoms that may occur after participation in the Chinese folk health enhancing practice of qigong ('exercise of vital energy'). Especially vulnerable are individuals who become overly involved in this practice.' Other cases of qigong deviation were fatal. These included individuals who starved to death while practicing, those who committed suicide in order to 'ascend to heaven', and those who died while committing dangerous acts out of delusions of omnipotence, such as jumping from a building with the intention of flying. These cases caused concern among the public and in state health authorities. They would also be taken up by anti-qigong polemicists as ammunition against the qigong sector." TheProfessor (talk) 12:23, 18 February 2014 (UTC)

thanks for extracts from these books! this is such a fascinating issue. The whole culture bound syndrome thing is complex. I am still trying to get a sense of the importance of qigong deviation. I am assuming (maybe a bad assumption) that Zhang Tongling is mentioned because she is super prominent or something. But treating 400 patients over 6 years (so say 70 patients a year?) in a city as big as Beijing (maybe around 10M in 1989?)... that is a tiny incidence, right? Jytdog (talk) 15:42, 18 February 2014 (UTC)

Qi Sensation (saved from older version, possible use in rewrite) Perhaps merge with Qigong deviation material, condense and include under Theory (or under Practice).

Eight typical sensations have been observed by qigong practitioners.[6]

  1. Motion – involuntary body movement or tingling sensation in muscle
  2. Itch – body becoming itchy
  3. Lightness – floating feeling
  4. Heaviness – the feeling of the body becoming very heavy or the feeling that a force is exerted on the body
  5. Cold – cold feeling
  6. Warm – warm feeling
  7. Rough – the feeling that the body is in contact with rough surfaces
  8. Smooth – the feeling that the body is in contact with smooth surfaces

The acquiring time, the strength and extent of the feeling on the body as well as the exact sensation vary widely between individuals. The "mind" part of qigong is the mental guiding of qi sensation (i.e. qi) through the body.[6]: 195–202  All qigong forms unanimously suggest that one should not be afraid of or excited by these feelings. They are just normal sensations during qigong practice. Out of control qi sensation, known as qigong deviation, is considered undesirable and potentially dangerous.[7]

TheProfessor (talk) 23:00, 27 February 2014 (UTC)

Sources

1) I found a recent source that is MEDLINE indexed as a review - it is a case study along with the review. Kuijpers HJ, Meditation-induced psychosis. Psychopathology. 2007;40(6):461-4. Epub 2007 Sep 11. PMID PMID 17848828. It is not focused on this issue alone, but discusses it at some length.

2) Kuijpers in turn cites Ng BY. Qigong-induced mental disorders: a review. Aust N Z J Psychiatry. 1999 Apr;33(2):197-206. PMID 10336217

3) I searched DSM-V, and this disorder is not discussed; it was dropped in the revision of DSM-IV, where it was discussed. DMS-V does have a section on culturally related disorders but doesn't include this. I have looked for a secondary source that says this, but I have not found one - my statement that it is not in DSM-V is my OR.

1) Kuijpers is behind a paywall - here is the discussion section: Over the past decades several case reports with short- lasting acute psychotic states associated with meditation have been reported (summarized in table 1). As can be inferred, almost all psychotic episodes had a short duration and were characterized by a mixture of psychotic and affective symptoms. About half of the patients had a psychiatric history, especially with psychotic symptoms. According to the clinical descriptions of ICD-10, most patients were suffering from an Acute and Transient Psychotic Disorder. In the DSM-IV they would have met the criteria for a Brief Psychotic Disorder. This type of psychosis with its several subtypes is well known in the German and French psychiatric tradition and has been recently reviewed by van der Heijden et al. [24] and classified in the ICD-10 among the acute polymorphic psychotic disorders with or without schizophrenia (F23.0 and F23.1). Although antipsychotics were administered in almost all case reports and in the present case, it is still unclear whether this treatment is useful or not. With respect to possible vulnerability factors, there seems to be an increased risk for meditation-related occurrence of psychotic symptoms in individuals with a history of psychiatric symptoms or with a certain personality structure, and in cases of sleep deprivation or physical exhaustion [5]. In the case reports presented in table 1, states of physical exhaustion were caused by fasting and sleep reduction during long-lasting, unguided and intense meditation, also described as malpractice of meditation [8]. As underlined by Ng [6] in his review about Qi-gong-induced mental disorders, psychotic deterioration is the result of meditation that acts as a stressor in vulnerable individuals. In Qi-gong cases, all Chinese authors describe a polysymptomatic psychiatric syndrome that corresponds to the Western categorical tradition so that the adoption of a separate class of culture-bound syndromes may not be appropriate. Therefore Lee [25] stresses that the Chinese classification system that includes the Qi-gong psychosis tries to conform with international classifications on the one hand and to sustain a nosology with Chinese cultural characteristics on the other. Meditation-induced psychotic states do not represent a separate clinical entity but are the result of a culture-bound nosology. In conclusion, meditation may act as a stressor in vulnerable subjects and may result in a rather specific psychotic syndrome: acute and transient psychotic disorder that most probably is self-limiting and therefore does not always require antipsychotic treatment.

What I take away from this, is that Kuijpers (and Lee) think "qigong deviation" is an incorrect mashup that is not helpful: it shouldn't be considered a separate category but should be considered as a meditation-triggered "psychotic syndrome: acute and transient psychotic disorder that most probably is self-limiting." No epidemiological data here.  :(

2)

  • Ng abstract, conclusion section:

Qigong remained veiled in secrecy and available only to the elite until the early 1980s. Despite the widespread use of Qigong, there is a conspicuous lack of controlled data regarding its effects on mental health. Qigong, when practised inappropriately, may induce abnormal psychosomatic responses and even mental disorders. However, the ties between Qigong and mental disorders are manifold, and a causal relationship is difficult to establish. Many so-called ‘Qigong-induced psychoses’ may be more appropriately labelled ‘Qigong-precipitated psychoses’, where the practice of Qigong acts as a stressor in vulnerable individuals.

  • discussion section:

Many of the studies on Qigong and mental health have been flawed by failing to follow the scientific method with sufficient rigor. Some, for instance, have no control subjects or have used sample sizes too small to be meaningful, while many are based on qualitative data, often idiosyncratically collected and described. Careful and replicable research with strict methodology has largely been lacking in this area..... To understand ‘Qigong craze’, one needs to appreciate the sociopolitical environment that China faced in the early 1980s, when revival of interest in Qigong coincided with the period when Chinese people were recovering from the destruction caused by the Cultural Revolution. ... When millions practise Qigong, casualties are not surprising. The concept of Qi, however, is not exclusively Chinese, for the Indian prana, the Greek pneuma, and the Hebrew ruakh all have much in common with it. It would be relevant to examine if phenomena similar to Qigong deviations occur in these cultures. ....The entity ‘Qigong-induced mental disorders’ actually includes a mixed group of neurotic and psychotic disorders [8]. A consensus on the classification of Qigong-induced mental disorders is lacking, and CCMD-2-R has not addressed this issue specifically. In the late 1970s, Cohen coined the diagnostic terms ‘Qigong psychosis’ and ‘Qigong psychotic reaction’ as translations for the Chinese expression zou huo ru mo, ‘fire (the Qi) wild, devils enter’ [21]. It was only in 1994 that the term ‘Qigong psychotic reaction’ was included in the DSM-IV Glossary of Culture-Bound Syndromes [42]. DSM-IV fails to indicate that neurotic reactions can also occur following Qigong, a fact highlighted in the Chinese publications. Many of the fragments translated in this short paper have not appeared before in English and it is hoped that this paper would help bridge the gap between Chinese and American psychiatry. It is important to realise that the inducer role of Qigong has not been convincingly proven. If it were not for the fact that these patients had practised Qigong, the clinical phenomena are very similar to anxiety disorder, conversion disorder, dissociative disorder, obsessional disorder, schizophrenia and other psychotic conditions, and are therefore quite protean. Zhai [18] distinguishes between two types of psychosis following Qigong practice: schizophrenia-like psychosis and relapse of schizophrenia.... Many so-called ‘Qigong-induced psychoses’ could be seen as ‘Qigong-precipitated psychoses’, where practice of Qigong acts as a stressor in vulnerable individuals. A small proportion of any case sample of people who practised Qigong and studied over time will probably have a mental disorder because of the onset of the disorder during this time.

Kuijpers seems to be following the lead that Ng laid down - we don't have good data that there is a causal link; seems more more likely to be more of a "trigger". no epidemiological data here either.  :(

Medical Research Rewrite - Scope and Outline

I suggest that as a backdrop for effective rewrite of the Medical Research content we 1) develop a clear scope of content, expressed as questions to be addressed; and 2) develop a clean outline to organize and guide the rewrite. In the bigger picture, we need to decide whether to separate medical research as a primary section, or include it as a subsection under Health, Research, or some other Heading.

Scope: Questions to be Addressed:

  • Is qigong safe?
  • Is qigong effective?
  • What conditions may benefit from qigong, and has this been studied?
  • What are the findings?
  • What is the quality of the research?
  • Is there a scientific consensus about effectiveness?
  • If there is not scientific consensus, what are the views (mainstream, multiple, minority, alternative...)?
  • Why don't we know more?
  • Will we ever know more?
  • Are there actively funded research programs?

General Outline

I. Medical Research

A. Background/Overview
B. Effects
C. Safety
D. Quality of Research
E. Scientific Consensus
F. Impediments and Prospects

Detailed Outline

A. Background/Overview
1. Conditions studied
2. Studies meeting scientific standards (RTCs)
3. Findings
4. Quality of research
5. Overview of Impediments and Prospects
6. Overall Conclusion

TheProfessor (talk) 13:07, 21 February 2014 (UTC)

Thanks for this carefully thought out proposal. However it feels kind of created from whole cloth rather based on existing article models. Perhaps we should follow WP:MEDMOS (worth a read if you haven't read it). And we should maybe model it on the "Drugs, medications and devices" section - the one about interventions. What do you think? Also the last question (will we ever know more?) and the "prospects" aspects are, I think, generally outside the scope of Wikipedia articles as per WP:CRYSTAL. Jytdog (talk) 13:09, 21 February 2014 (UTC)
Good points. I think we need to steer a middle course, between the ideal content and what is driven by existing sources. The WP:MEDMOS "Drugs, medications and devices" model is worth considering, though only partly applicable. Let me know if you have specific suggestions, like using the language of some of the headings (Medical uses, Contraindications, Adverse effects, Interactions, Mechanism of action, History, Society and culture, Economics, and Research, etc.). Yes, let's eliminate "will we ever know more?". What about replacing it with "Are there actively funded research programs?"). Prospects would really depend if there is a good MEDRS source that sets a research agenda or offers commentary about the future. How could we capture evolving changes to the proposed outline? TheProfessor (talk) 14:28, 21 February 2014 (UTC)

Actually there is a "surgery and procedures" outline... i'd like to propose the following mashup of the drugs outline and the surgery/procedure outline in order to catch as many of the sections you mention above....

what do you think? Jytdog (talk) 23:37, 22 February 2014 (UTC)

Thanks, Jytdog. I'm wondering how the medical article model applies in an article that is not primarily medical, given that medical content may primarily belong under categories like Effectiveness, Safety, Mechanism, or Research, and that medical content may be interwoven with non-medical history, society and culture, health, martial arts, as well as conventional, Traditional Chinese Medicine (TCM), Complementary and Alternative Medicine (CAM) content. By the way, among scholars and Oriental Medical Doctors, there is often a distinction between "traditional" and "classical", with "traditional" actually arising in modern times under strong political influence to make elite knowledge available to the masses, sanitizing and homogenizing diverse older elite traditions, and with "classical" referring to these pre-Maoist approaches.
The medical mashup model would be good for a stand-alone article, and could help guide language choice and content for major sections, subsections, or topics of the existing article. It makes sense to consider organization with respect to other related Wikipedia articles, in particular TCM, Acupuncture, Tai Chi, and History of Qigong articles. In terms of bigger picture organization, please consider these options: 1) interwoven conventional, TCM, and CAM perspectives; and 2) distinct sections or subsections concerning conventional medicine, TCM, and CAM. Also consider developing a separate comprehensive conventional medical article, like was done for Qigong History. It would help to agree on an outline for the overall article and the scope of the medical content. TheProfessor (talk) 15:50, 23 February 2014 (UTC)
Hm! Why do people do qigong? Jytdog (talk) 16:11, 23 February 2014 (UTC)
Sorry that was a real question, but I am not sure you took it that way. In my mind, people engage in qigong for health benefits. General well being for sure, but apparently specific indications can become very important as well, as evidenced by the drama we just went though. MEDRS and MEDMOS govern health related content (not just narrowly "medical"). I think we could use MEDMOS to structure the whole thing very nicely! The current structure and your proposed structure also map onto the MEDMOS structure well, I think. With regard to structuring it like the TCM article, I am not sure how that is a helpful model; it is a broad overview of the whole field, not a specific set of practices. Maybe you could explain that more? The acupuncture article is more relevant, I think (TOC is pasted below). It is also kind of a mashup of MEDMOS. I would be comfortable going with a parallel structure here. What you write above about the history (traditional vs classical) is already discussed in the article and yes we should keep that for sure! Jytdog (talk) 17:37, 23 February 2014 (UTC)

table of contents of acupuncture article... History 1.1 Antiquity 1.2 Middle history 1.3 Modern era 2 Theory 2.1 Qi, meridians and acupuncture points 2.2 TCM concept of disease 2.3 Traditional diagnosis 2.3.1 Tongue and pulse 2.4 Scientific view on TCM theory 3 Clinical practice 3.1 Needles 3.2 Needling technique 3.2.1 Insertion 3.2.2 De-qi sensation 3.3 Related practices 4 Effectiveness 4.1 Cancer 4.2 Fertility and childbirth 4.3 Nausea and vomiting 4.4 Stroke 4.5 Pain 4.5.1 General 4.5.2 Peripheral osteoarthritis 4.5.3 Headaches and migraines 4.5.4 Low back 4.5.5 Post-operative 4.5.6 Miscellaneous 4.6 Other conditions 5 Safety 5.1 Adverse events 5.2 Cost-effectiveness 5.3 Risk of foregoing conventional medical care 6 Reception 6.1 General public 6.2 Government agencies 6.3 International organizations 6.4 Public organizations 6.5 Skepticism 7 Legal and political status 8 See also 9 Bibliography 10 Notes 11 References 12 Further reading 13 External links

Pretty useful I think.... Jytdog (talk) 17:37, 23 February 2014 (UTC)

Why people practice qigong is a good question, and yes, many people practice qigong for health benefits. Other reasons include recreation, martial arts training, and spirituality. Also, qigong is often part of the required or optional curriculum for accredited schools that train Oriental Medical Doctors and Acupuncturists, and many practitioners consider it an essential part of their professional practice. Many start because of a specific illness, or problem that requires gentle exercise. I'm not entirely clear about your point of this relates to the structure - definitely relevant to the questions that define scope.
I mentioned consideration with respect to other articles: the TCM article because Qigong is often consider a subset of of TCM (same for Martial Arts); the Qigong History because this split off when it became big and warranted a separate article; and the Acupuncture article because it is probably a good model, as you point out, and where we got the current structure (buried somewhere in the archives, as modified through time). Let's get specific about an overall outline for the article.

Qigong Article Outline

1 Qigong basics
1.1 Etymology
1.2 History
1.3 Forms
1.4 Typical Practices
2 Application
2.1 Health
2.2 Meditation and self-cultivation
2.3 Martial arts training
3 Theory
3.1 Principles and Technique
3.2 Traditional view
3.3 Contemporary view
3.3.1 Conventional Medicine
3.3.2 Complementary and Alternative Medicine
4 Health
4.1 Popular and Medical Use
4.2 Effectiveness
4.3 Safety
4.4 Mechanisms
4.5 Impediments to Research
5 Controversy
5.1 Social and Political Controversy
5.2 Health Controversy
6 Conclusion: Shifting views

TheProfessor (talk) 18:55, 23 February 2014 (UTC)

Hey professor. I have been reflecting about this a lot. My interest in Wikipedia is claims made about health effects (both good ones, and bad ones (eg. toxicity)). If you want to do an overhaul of the whole article, that is great but I won't be involved in that. What I am interested is health-related content. So I will have nothing to to say about the big picture of the article structure or its content. So I am interested in sections 2.1, 3.3, and all of 4 and 5.2, in what you write above. Some questions! (feel free to answer after each question, if you like. I have signed each one so the threading will be clear.) Thanks for continuing to talk~ Jytdog (talk) 01:10, 24 February 2014 (UTC)
Thank you for explaining that you prefer to focus only on the health-related content. TheProfessor (talk) 05:43, 25 February 2014 (UTC)
  • I don't understand the duplication (neither in the existing structure nor in the proposal above). Why have 2 sections discussing health? Maybe it would be worthwhile having something like a single sentence under 2.1...Jytdog (talk) 01:10, 24 February 2014 (UTC)
Yes, this follows the current structure, with a basic overview of health, martial arts, and philosophy/self- applications, and then more in-depth with Health (previously "Health benefits"). I am now thinking it would be cleaner to bring all of Health together, and to have separate major headings for Martial Arts and Philosophy and self-cultivation, with a brief introduction to the three applications under 1.3 Forms. TheProfessor (talk) 05:43, 25 February 2014 (UTC)
ok great. Jytdog (talk) 13:16, 26 February 2014 (UTC)
  • What is the difference between "popular" and "medical" uses in 4.1 (a health section). If you are getting into its use for exercise and meditation vs its use in CAM centers, I get that. Maybe you also want to get into health claims made from within the paradigm of TCM here? Jytdog (talk) 01:10, 24 February 2014 (UTC)
Yes, my thought was to have a place for recreation, exercise, meditation, and other popular use; and I was wondering how to handle CAM and TCM uses. On further reflection, I suggest we include separate subsections for Recreation and Popular Use (or simply Recreation) versus Medical Use. In terms of where to place TCM and CAM uses, I suggest all could be together under Medical Use, but in distinct paragraphs, with qualifiers like "Acccording to the TCM perspective" or "According to the CAM perpective". Another possibility would be in separate TCM and CAM subsections, but this could mean a proliferation of subsections. TheProfessor (talk) 05:43, 25 February 2014 (UTC)
Responding to this, with the point below... Jytdog (talk) 13:16, 26 February 2014 (UTC)
  • What goes in 4.1 vs 4.2? Jytdog (talk) 01:10, 24 February 2014 (UTC)
Good question. In terms of Medical use, this would include a list conditions for which qigong is commonly used. What do you recommend in terms of MEDRS? I assume there would also be a concise statement of use from TCM and CAM texts. In terms of Effectiveness, presumably would include review of RTCs, their findings and reliability, and the overall medical conclusion that "it would be unwise to draw firm conclusions at this stage". What are your thoughts? TheProfessor (talk) 05:43, 25 February 2014 (UTC)
I kind of thought this is what you were doing.. how about if 4.1 is Well-being and we discuss how regular qigong practice for whatever reason (meditation-y, recreation, martial arts, exercise, etc) contributes to well being, with MEDRS sources (this is health information) and we call 4.1 something like "Medical" or maybe better "Directed use" and we discuss the use of qigong intentionally to treat patients with a specific condition, along with discussion of effectiveness. In Wikipedia we generally discuss health practices and their effectiveness together; this would follow standard procedure. would that be ok?
  • Unclear what goes in 4.4 that is not discussed that would not be discussed in 3.3. Can you please explain? Jytdog (talk) 01:10, 24 February 2014 (UTC)
Yes, Mechanisms and Contemporary View could be combined and placed as the last section of Theory, unless you see a reason to separate theory and findings of mechanistic studies? TheProfessor (talk) 05:43, 25 February 2014 (UTC)
Great, yes, let's do consolidate in 3.3 theory. I think the division there is practical and workable. Jytdog (talk) 13:16, 26 February 2014 (UTC)
  • What content do see going into 3.3.1 vs 3.3.2? This is a little worrisome. Jytdog (talk) 01:10, 24 February 2014 (UTC)
What troubles you? I suggest we eliminate 3.3.1 and 3.3.2, since this is not addressed in the current text, which emphasizes analysis "limited to the effect of qigong practice on biological processes without demanding a material interpretation of qi". Depending upon reliable sources, we could resurrect older text from the archive: "The basis of qigong can also be explained in terms of contemporary views of health, science, meditation, and exercise, and using medical concepts such as stress management, biofeedback, and neurology". TheProfessor (talk) 05:43, 25 February 2014 (UTC)
So hm. This is perhaps the hardest part of the article. I think it is reasonable to offer an explanation from within the TCM perspective of how qigong works, appropriately framed. That would be under 3.2. Then we should have a frank discussion of what science says about mechanisms by which qigong could be effective for anything under 3.3. btw, as i reviewed and reflected, i don't understand what goes in 3.1 that would not be in 1.3 and 1.4... maybe we should actually move section 3 up and make it section 1, followed by the current section 1? then the current 1.3 and 1.4 would flow more cleanly from the basic principles and technique....  ? Jytdog (talk) 13:16, 26 February 2014 (UTC)
  • Finally, with regard to 5.2, you might find this bizarre, but I don't know what goes there. Our recent drama aside (which I don't view as a mainstream interaction), do you see real controversy in the English speaking world about health effects of qigong? Some of what is there I don't see as controversial at all and will be addressed in sections we are going to implement; other aspects may be a bigger deal in China (?) than here; other aspects seem to be strawmen and not really worth discussing. But I don't know much about this and am interested in your take on this. Jytdog (talk) 01:10, 24 February 2014 (UTC)
Interesting. Maybe not so bizarre… Would you favor eliminating 5.2, retaining appropriate sourced text back in other sections? TheProfessor (talk) 05:43, 25 February 2014 (UTC)
Thanks for bringing the content below - that is super-helpful. Liu and Qiang 2013 seem to come from a great science-based perspective (although some folks I have been interacting here would rip on them for giving even the possibility of there being some reality to external qi....) But yes I think most of that discussion will be already covered in what we do above; I think we can do away with it. Jytdog (talk) 13:16, 26 February 2014 (UTC)
In terms of controversy, here is what Liu and Qiang 2013 write about controversy
Liu, Tian Jun, and Xiao Mei Qiang (editors). 2013. Chinese Medical Qigong, Third Edition. Singing Dragon, London and Philadelphia. pp. 88-89 Controversy.
"Main Issues in Dispute
From the 1950s up to today, there have been basically two matters of dispute concerning Qigong and its research. Presented in chronological order, the first discussion regards the definition or purpose of Qigong, and the second involves the existence and description of“external Qi.”
I. Definition of Qigong
Controversy over the definition of Qigong started in the mid-1950s when Qigong therapy started gaining popularity, and continues to the present.
There have been three main opinions on this issue. First, Qigong practice is equivalent to psychological adjustment. Qigong therapy is, therefore, no more than a psychological therapy developed to be consistent with the characteristics of traditional Chinese culture. The second definition was based on the interpretation that Qi refers to the air,ii or in broader terms, the energy transformed from air and food to animate and sustain human life. Qigong is viewed as a method or technique to regulate the energy of life activities. Third, that Qigong consists of mental as well as physical maneuvering skills which apply to the adjustment of body posture, breathing, and mind. The core concept of this definition is the Qigong state of adjusting those three into one. This book holds the third view.
2. External Qi of Qigong
Debates on the issue of external Qi started in the late 1970s and have been even fiercer than the disputes on the definition of Qigong.
Three opinions remain. First, external Qi is a form of energy, similar to that of sound waves, lightwaves, electricity, or particles in physics. Though differing in intensity, it is of the same nature as the electromagnetic radiation of the human body. In a broader sense, it may be a form of energy still unmeasured and undefined. The second opinion is that external Qi is nothing but a psychological effect. Therefore, the therapeutic effect of external Qi is caused by psychological suggestion, and will disappear once the suggestion is removed. The third opinion is that the effect of external Qi partially results from psychological factors, but the possibility of its being caused by energy emitted by a practitioner cannot be excluded either.3 Current research on external Qi is inadequate to draw any definite conclusion and further research is necessary. This book follows the last opinion.
In Sections 2 and 3, typical programs and conclusions with regard to Qigong research in the fields of physiology, psychology, biochemistry, immunology, and physics are introduced. The aim is to introduce readers to new possibilities, and familiarize them with the scope and methodology of modern research on Qigong. Please note that consensus has been achieved for the interpretation of some research results, but for other areas, interpretation is still in discussion.
In addition, results from any experiment are dependent on the Qigong methods selected and the levels of practitioner compliance and mastery. The effect induced by Qigong practice has a lot to do with both methods and application of practice. The result of experiments, for instance, may differ considerably for beginners and seasoned practitioners of either Relaxation Qigong or hard (martial-art) Qigong. Note that all the Qigong forms introduced in the following sections, if not specified, are of the relaxing and meditative type of Qigong, and the practitioners are experienced (masters), not beginners."
TheProfessor (talk) 06:14, 26 February 2014 (UTC)
Including any further input, would you recommend I update the outline above or produce a new version below? TheProfessor (talk) 05:43, 25 February 2014 (UTC)
Are you satisfied with the list under Scope: Questions to be Addressed? Presumably it would be good to have a question about mechanism. TheProfessor (talk) 05:50, 25 February 2014 (UTC)
i made some proposals above about re-arranging and don't know what you think yet.. Jytdog (talk) 13:16, 26 February 2014 (UTC)
Thanks for the thoughtful input Jytdog. If I am clear about what you are communicating, 1) under Health, you suggest Wellbeing and Directed use as categories, and combining Medical use and Effectiveness content under Directed use, and 2) move Principles from Theory up front, and 3) eliminate Controversy. I would like to consider the Wellbeing/Directed Use categories further; I already partly came to the the same conclusions about reorganization; and I'm not sure about eliminating the Controversy section. Let's update the overall outline and see where we stand. Maybe you could make a numbered list of points requiring discussion, including specific suggestions. I'm having a bit of problem tracking multiple threads. TheProfessor (talk) 15:25, 26 February 2014 (UTC)

Here is a new draft outline. Note that Practices provides an overview of typical qigong activities (moving meditation, still meditation, sound meditation, massage, internal vs external practice...); Forms summarizes the diversity of qigong forms, with examples of commonly practiced forms; and Techniques consists of content from what is currently called Principles (moved up from Theory). Controversy is eliminated as a separate section, but can readily be added back in if warranted.

Qigong Article Outline - Draft, Feb 27, 2014

1 Qigong basics
1.1 Etymology
1.2 History and origins
2 Practices, forms, and technique
2.1 Practices
2.2 Forms
2.3 Technique
3 Traditional and classical theory
3.1 Chinese medical qigong
3.2 Daoist qigong
3.3 Buddhist qigong
3.4 Confucian qigong
4 Contemporary view
4.1 Prevailing viewpoints
4.2 Scientific basis
4.3 Impediments to research
5 Health applications
5.1 Recreation and popular use
5.2 Directed use
5.3 Safety
6 Meditation and self-cultivation applications
7 Martial arts applications
8 Conclusion: Shifting views
Could we agree on a structure and move to detailed outlines for health and medical content? How do we handle interweaving medical and non-medical content? TheProfessor (talk) 12:35, 27 February 2014 (UTC)
I think this is great, thanks so much for doing this so carefully! It is just the two of us working now and it is not unlikely that somebody else is going to come along later who may disagree a lot, or a little. So rather than further refining, let's turn to the article! I don't know that we need to interweave too much. 4 and5 will be science based; there is nothing to interweave. Anything said in 3 needs to be framed as "Chinese medical qigong holds that..." etc - not statements directly about reality per se. Does that work for you? Jytdog (talk) 12:58, 27 February 2014 (UTC)
Thank you for your input! Yes, let's turn to the article. Most of the current content parses readily into the new headings, and only requires modest initial rewrite, with eventual more extensive rewrite. I went ahead and started by setting up the new major headings and redistributing text. Qi Sensation is temporarily deleted and placed with the Qigong deviation text saved on the Talk page. Training methods is moved to 2.1 Practices. Medical Research and Mental health are now under 5.2 Directed use. Deleted qigong deviation should mostly go under 3.1 Chinese medical qigong. The content of 2.1 Health is now under 5.1 Recreation and popular use, and part may go in 5.2 Directed use. Etc. Yes, let's use appropriate qualifiers to ensure that content of 3 Traditional and classical theory clearly and neutrally represents traditional and classical perspectives. By the same token, there is probably some medical and non-medical content to interweave in 4 and 5, but it does not need to be contentious if we use appropriate qualifiers. I'd still like to develop details of content for 4 and 5, using questions to be addressed and a detailed outline, so we can be complete and clear in our writing, and insofar as possible to resolve differences of opinion up front. TheProfessor (talk) 00:28, 28 February 2014 (UTC)
  1. ^ Lee MS, Pittler MH, Guo R, Ernst E (August 2007). "Qigong for hypertension: a systematic review of randomized clinical trials". J. Hypertens. 25 (8): 1525–32. doi:10.1097/HJH.0b013e328092ee18. PMID 17620944.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  2. ^ Lee MS, Pittler MH, Ernst E (November 2009). "Internal qigong for pain conditions: a systematic review". J Pain. 10 (11): 1121–1127.e14. doi:10.1016/j.jpain.2009.03.009. PMID 19559656.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ Lee MS, Pittler MH, Ernst E (November 2007). "External qigong for pain conditions: a systematic review of randomized clinical trials". J Pain. 8 (11): 827–31. doi:10.1016/j.jpain.2007.05.016. PMID 17690012.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ^ Lee MS, Chen KW, Sancier KM, Ernst E (2007). "Qigong for cancer treatment: a systematic review of controlled clinical trials". Acta Oncol. 46 (6): 717–22. doi:10.1080/02841860701261584. PMID 17653892.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ^ Cite error: The named reference Review was invoked but never defined (see the help page).
  6. ^ a b Ma Ji Ren 馬濟人 (1992). Practical Qigong for Traditional Chinese Medicine 實用中醫氣功學. Shanghai Scientific and Technical Publishers 上海科学枝术出版社. p. 466. ISBN 7532327205.
  7. ^ Chen, Nancy N. (2003). "Chapter 4. Qiqong Deviation or Psychosis". Breathing spaces: qigong, psychiatry, and healing in China. Columbia University Press. pp. 77–107. ISBN 0-231-12804-5. {{cite book}}: Cite has empty unknown parameter: |month= (help)
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