Qigong forms (Baduanjin, Yijinjing, Wu Qin Xi, Liu Zi Jue)

1. Introduction

Version followed: the four "Health Qigong" (健身气功, jiànshēn qìgōng) sets standardised in China under the General Administration of Sport's Health Qigong Management Center and the Chinese Health Qigong Association (CHQA): Baduanjin (八段锦), Yijinjing (易筋经), Wu Qin Xi (五禽戏) and Liu Zi Jue (六字诀), as described by CHQA-linked teaching bodies, a Singapore government health portal and Chinese-language public sources. Asahi Health, a Finnish qigong-derived practice, is covered briefly. Translations from Chinese are the author's own and marked "(tr.)".

This is not a single psychotherapy but a family of standardised, gentle movement sets that combine slow movement, breathing and focused attention. The Singapore Health Promotion Board describes Health Qigong as a "Mind Body Exercise" with three focus areas: posture and movement, breath, and meditative mind [source: HealthHub Singapore]. The four sets are presented as derived from traditional practice and aimed at health maintenance [source: HealthHub Singapore].

How change happens, in the tradition's own terms: practice is said to regulate body, breath and mind and so to harmonise the flow of qi (气, often rendered "vital energy") through the body; the movement names themselves encode claims about organs, "heart fire" and the "triple burner" (see 4.5). These are concepts of Chinese medicine and Daoist-influenced self-cultivation, attributed to the tradition and not established physiology [source: HealthHub Singapore; The Paper 2023]. In psychological terms [synthesis]: repeated slow movement with attention to breath and bodily sensation may train attention, interoceptive awareness and arousal regulation; group classes add behavioural activation, structure and social contact. Meta-analyses suggest qigong is "potentially beneficial" for depressive symptoms, with weak and heterogeneous trials and less consistent findings for anxiety (see 2.5).

Qigong forms are not a treatment for cancer or any other physical disease. Health claims made for them (bone density, immunity, curing "the hundred illnesses") are attributed to their proponents in this guide and given an evidence status where one exists.

Scope note on "qigong healing" and "external qi": some practitioners claim to heal others by emitting qi (外气, wàiqì, "external qi" (tr.)). This is a separate, contested practice from the standardised self-practice sets; it is described in 4.13 with its evidence status.

Who holds teaching authority: in mainland China, Health Qigong is administered as a sport by the state sports authority. The 2006 Health Qigong Management Measures (《健身气功管理办法》, effective 20 December 2006; a departmental rule issued as General Administration of Sport Order No. 9) set ranks of social sports instructor (社会体育指导员（健身气功）) at national, first, second and third grade, conferred by sports authorities at national, provincial, prefecture and county level; in 2021 the Health Qigong Management Center issued trial rules creating three levels (junior, intermediate, senior) of "Health Qigong exercise-prescription practitioner" (健身气功运动处方师), with training, a theory exam, a skills test and registration with CHQA [source: The Paper 2021]. Under the 2006 Measures, organising Health Qigong activities or setting up practice stations without authorisation can be shut down by the sports authority together with the police [source: Yinchuan Sports Bureau accountability list]. The General Administration of Sport has issued eleven standard Health Qigong forms [source: Sina 2024]. Internationally, the International Health Qigong Federation (IHQF, Beijing, formed around 2011) links CHQA to national associations and manages training of coaches and referees; one member school's 2016 blog describes a CHQA "Duan" (段, rank) grading of nine levels as an optional benchmark, alongside basic, intermediate and advanced instructor courses then being planned [source: JinLi 2016; uncertain: secondary, unverified]. A Duan grading is in official use in China: a 2025 Beijing competition regulation, issued under the guidance of the Health Qigong Management Center and CHQA, applies trial Measures for Evaluating Health Qigong Sport Proficiency Levels (Duan) (《健身气功运动水平等级（段位）评定办法（试行）》), under which competition results count towards Duan assessment [source: Beijing Health Qigong competition rules 2025]. The number of levels and how Duan ranks are awarded outside China are not confirmed by an official source [uncertain]. Ask any teacher who cites a Duan rank which body issued it. No government regulation of qigong teaching outside China is cited here [uncertain].

Asahi Health: created in Finland in 2004 by Timo Klemola, Ilpo Jalamo, Keijo Mikkonen and Yrjö Mähönen, drawing on tai chi, qigong, yiquan and yoga with a Western exercise-science outlook; slow movements performed in silence, usually in groups. After the founders separated (2014), Mähönen and Jalamo founded Asahi Nordic ry (international wing Asahi World), and Mikkonen continued under the Asahi Health name. Its organisations describe it as self-care comparable to physiotherapy and as calming; independent evidence is limited to a small student balance project [source: Wikipedia, Asahi Nordic and Asahi Health]. Treat its claims as promotional.

2. Framework

The developers publish class sets, not a psychotherapy protocol. The phases below organise how a psychotherapist works with the forms; phase content is drawn from the sources cited, and the sequencing is [synthesis].

2.1 Two delivery routes

Route A (referral, most therapists): the client attends a Health Qigong class taught by a qualified instructor; the therapist screens, prepares, monitors and integrates. [synthesis]
Route B (therapist teaches): a psychotherapist who has completed recognised Health Qigong instructor training (a CHQA/IHQF-affiliated national association course, or in China the social sports instructor or exercise-prescription practitioner route) may lead a group using the standardised sets. IHQF-linked instructor training has been run as intensive multi-day courses with theory, Chinese medicine seminars, practice and assessment, with certificates issued under CHQA authority [source: JinLi 2016, Oceania course]. Do not teach the sets from videos or books alone [synthesis; Shan 2000 links self-teaching to adverse reactions].

2.2 Phases

Screening and decision (before any practice): physical screening and medical clearance; psychiatric screening for psychosis, dissociation, mania and trauma (4.1, 4.2). Move on when cleared, or choose an alternative.
Preparation (one or more therapy sessions): psychoeducation including the possibility of unusual sensations and how to stop (4.3); choosing the set and teacher (4.4). Move on when the client can name what they will do if they feel unwell during practice.
Learning (a course of classes): learn the movements first and add breathing later; keep range of movement small at first [source: The Paper 2023]. Move on when the client can follow a set without strain or distress.
Integration and consolidation: debrief experiences in therapy (4.11); continue practice as the teacher advises.
Ongoing practice or ending: home or group practice continues as the teacher advises; the therapist reviews benefit and harms periodically.

Typical session count and format: the sources consulted give no standard course length for Health Qigong classes [uncertain]. Classes are usually group-based; a published class pattern is warm-up, practice of the form, and a closing settling activity such as lightly tapping the head or rubbing the ears [source: The Paper 2023]. Seated versions and the freedom to rest or skip any movement are used in at least one hospital-based qigong programme [source: UCSF Osher Center FAQ; that programme teaches a different qigong system].

2.3 Criteria to stop or pause (any phase)

New or worsening psychotic, manic or dissociative symptoms; persistent sensations of "qi rushing" to the head with headache, dizziness or fear; inability to stop practising; falls or pain. Stop practice and assess (4.12) [source: Shan 2000; synthesis].

2.4 Who should not start without specialist advice

People with an existing medical condition should consult their doctor first [source: HealthHub Singapore]; people at risk of falls are advised not to train (存在跌倒风险的患者不宜训练, "patients at risk of falls should not train" (tr.)) [source: The Paper 2023]. For mental-health cautions see 4.2.

2.5 Evidence status (for informed consent)

Wang et al. (2013), 12 RCTs: qigong beneficial for depressive symptoms against waiting list or usual care, newspaper reading groups and walking or conventional exercise; no clear benefit for anxiety; results to be read with caution because of few trials and methodological weaknesses [source: PolyU repository record].
So et al. (2019), 7 studies meta-analysed: small effect on depression (SMD about −0.27); authors call for higher-quality studies [source: PolyU abstract page].
Liu, Zhang and Zhao (2024), 10 studies during COVID-19: traditional Chinese exercise including Baduanjin reduced anxiety and depressive symptoms, with very high heterogeneity [source: Frontiers in Public Health].
Benefits for bone loss, immunity, fitness and falls are claimed by the Singapore portal without study-level detail in its text [source: HealthHub Singapore]; they are not reviewed here and are no basis for replacing medical care.
Qigong is an adjunct, not a replacement, for evidence-based treatment of depression or anxiety disorders [synthesis].

3. Guiding principles

Safety first: a published Chinese practice guide stresses moderation and a safety-first approach → screen, start small, stop at any discomfort [source: The Paper 2023].
Movements before breath: beginners learn the movements first and add breath coordination later → never coach breathing patterns early, and never give breath-retention instructions [source: The Paper 2023].
Gentle, slow, small range: rotations and squats slow and gentle, range small at first → adapt for joints and balance; offer seated options [source: The Paper 2023; UCSF Osher Center].
Learn from a qualified teacher, not alone: in the largest reported Chinese series most people with qigong-related disorders had practised alone → refer to credentialed teachers; Route B only with training [source: Shan 2000].
Not every method suits every person: choose a method according to the person's condition → match set to client; avoid methods that encourage trance, spontaneous movement or chasing special experiences [source: Shan 2000; second clause synthesis].
Psychological education before and after starting: recommended to prevent qigong-related disorders → prepare clients and debrief [source: Shan 2000].
Attribute, don't assert: qi, meridians, organ functions and "heart fire" are the tradition's concepts → use "in qigong tradition, this is understood as…" [synthesis, in line with professional honesty].
Client choice and right to opt out: participants may pass or rest during any practice → state this at every class [source: UCSF Osher Center].
No cure claims: no form is a treatment for physical disease → correct cure claims and keep medical care in place [synthesis].
Stay within competence: offer only methods you are trained in, and refer when appropriate → UKCP item 23 requires adequate training for forms of therapy offered; APA Standard 2.01 requires practice within competence (APA code) [source: UKCP Code 2019; APA Ethics Code].

4. Intervention inventory

The standardised sets are described below in general terms only: names, character and purpose as published. They are not reproduced as step-by-step instructions, and no counts, durations, intensities or breath timings are given; these belong to the qualified teacher. Steps given are the psychotherapist's steps around the practice.

4.1 Physical screening and medical clearance

Purpose: identify people who need medical advice or adaptations before starting; required before Route A or B.
Steps: (1) Ask about existing medical conditions, recent surgery, joint or spinal problems, dizziness, balance problems and falls, cardiovascular conditions and pregnancy [synthesis on the list; consulting a doctor with any existing condition is advised by HealthHub Singapore]. (2) Anyone with a medical condition: ask them to consult their doctor before starting and record the outcome [source: HealthHub Singapore]. (3) Fall risk: a Chinese practice guide advises that people at risk of falls should not train; discuss seated adaptations with the teacher and the client's doctor or physiotherapist instead [source: The Paper 2023; adaptation is synthesis]. (4) Tell the client and teacher what was found (with consent).
Example language (illustrative): "Before you join a class, I'd like to check a few health things, and if you have any medical condition, please run it past your doctor first. That's the standard advice for Health Qigong."
Watch for: minimising ("it's only gentle"); undisclosed falls; clients planning to use qigong instead of medical treatment. Working: client has clearance or a clear adaptation plan.

4.2 Mental-health screening for qigong-related reactions

Purpose: reduce the risk of qigong-related psychotic, dissociative or anxiety reactions (see 4.12).
Steps: (1) Ask about any history of psychosis, mania or bipolar disorder, dissociative episodes, severe anxiety or panic, trauma with flashbacks or dissociation, and family history of psychosis. (2) Ask about previous qigong or meditation experiences: sensations of energy rushing, spontaneous movements, visions, voices, feeling possessed. (3) Ask about motivations: seeking special powers, rapid mastery, or escape [risk features named by Shan 2000 and the traditional account summarised on Wikipedia, Zouhuorumo]. (4) For current psychosis or mania: defer; discuss with the treating psychiatrist. For a past episode, dissociation or complex trauma: proceed only with a slow, eyes-open, movement-led set with a teacher briefed on the risk, and closer monitoring [synthesis]. (5) Record the decision.
Example language (illustrative): "A small number of people have had unusual experiences with qigong, such as feeling energy rushing to the head, or becoming very confused or frightened. It's rare, but it's more likely if someone has had psychosis or strong dissociation before. Has anything like that happened to you?"
Watch for: strong interest in "opening" channels, trance or supernatural abilities; past episodes after meditation retreats; current substance use [last item synthesis]. Working: client and therapist share a clear plan for stopping and getting help.

4.3 Psychoeducation before starting

Purpose: Shan (2000) recommends adequate psychological education before and after starting qigong to prevent qigong-related disorders.
Steps: (1) Explain what Health Qigong is: slow movement, breath and attention, taught as health exercise [source: HealthHub Singapore]. (2) Explain that qi and organ ideas belong to the tradition; the client may hold or not hold them. (3) Explain normal experiences (warmth, tingling, calm, mild muscle fatigue) [synthesis] and warning signs (racing thoughts, voices, feeling controlled, persisting sensations of energy rushing to the head, uncontrollable movements, inability to stop) [source: Shan 2000]. (4) Agree a stop rule: stop, open the eyes, walk, ground, tell the teacher, contact the therapist [synthesis]. (5) Explain that qigong is not a treatment for physical disease and does not replace medication or therapy.
Example language (illustrative): "Most people find it calming. If you ever feel something rushing in your head, hear things, or can't stop moving, stop straight away, open your eyes, walk around, and tell your teacher and me. That's not a sign of progress; it's a sign to pause."
Watch for: client framing alarming sensations as spiritual achievement; fear-based avoidance after hearing the risks. Working: client can repeat the stop rule.

4.4 Choosing a set and a teacher

Purpose: match a credentialed teacher and a suitable set to the client.
Steps: (1) Ask the teacher about training and credentials: a national Health Qigong association affiliated to IHQF, CHQA certificates, Duan rank, or in China the social sports instructor (Health Qigong) grade or exercise-prescription practitioner level [source: The Paper 2021; JinLi 2016]. (2) Ask how the class is run: warm-up, form practice, closing; whether seated options and rest are allowed; how unusual experiences are handled [synthesis on questions; class pattern from The Paper 2023]. (3) Prefer the standardised sets, taught as health exercise, over methods emphasising trance, spontaneous movement, emission of qi or special powers [synthesis drawing on Shan 2000]. (4) Consider set fit: Baduanjin is described as simple and easy to learn; Wu Qin Xi as imitative and expressive; Liu Zi Jue as breath and sound-based, which may suit or unsettle anxious clients; Yijinjing as stretching and spinal work, which needs attention to the spine and joints [descriptions from HealthHub Singapore; fit judgements synthesis]. (5) Red flags: cure promises, demands to stop medication, large fees for "higher" secret levels, touch without consent, discouraging contact with doctors or therapists [synthesis].
Example language (illustrative): "When you call the teacher, it's fine to ask where they trained, whether you can sit or skip moves, and what they do if someone feels unwell. A good teacher won't mind."
Watch for: dependence on a charismatic teacher; teacher's dismissal of medical care. Working: the client attends a class with a teacher who welcomes questions.

4.5 Baduanjin (八段锦, "eight pieces of brocade" (tr.); described as "eight excellent movements")

Purpose: a short, simple set described as gentle, slow and smooth and easy to learn, which makes it the usual first choice for beginners and older adults [source: HealthHub Singapore; The Paper 2023]. Evidence for anxiety and depressive symptoms: see 2.5 (Liu et al. 2024).
The eight movements, by their traditional names [Chinese names: The Paper 2023; translations (tr.)]: 1. 两手托天理三焦, holding up the sky with both hands to regulate the "triple burner"; 2. 左右开弓似射雕, drawing the bow left and right as if shooting a vulture; 3. 调理脾胃须单举, raising one arm to regulate spleen and stomach; 4. 五劳七伤往后瞧, looking back to remedy the "five strains and seven injuries"; 5. 摇头摆尾去心火, swaying head and tail to clear "heart fire"; 6. 两手攀足固肾腰, hands reaching to the feet to strengthen kidneys and waist; 7. 攒拳怒目增气力, clenched fists and glaring eyes to increase strength; 8. 背后七颠百病消, jolting the back so the "hundred illnesses" disappear. The organ and illness claims in the names are traditional Chinese medicine concepts, not established effects.
Steps (therapist): (1) Refer to a qualified class, or teach only after instructor training (Route B). (2) Check that the teacher adapts forward bends, neck turns and squatting movements for people with spinal, joint or balance problems; the practice guide advises slow, gentle rotations and squats and small range at first [source: The Paper 2023]. (3) Debrief after early classes (4.11).
Example language (illustrative): "The movement names come from Chinese medicine; you don't need to believe them to benefit from moving slowly and paying attention."
Watch for: neck or low-back strain, dizziness with head turns, balance loss; clients treating name claims (e.g. "hundred illnesses disappear") as literal promises [synthesis]. Working: client reports steadiness, calm or improved mood without strain.

4.6 Yijinjing (易筋经, "tendon-changing classic" (tr.))

Purpose: a set described as turning, bending, extending, pulling and drawing the muscles, bones and joints, especially the spine; smooth, combining softness and strength [source: HealthHub Singapore].
Steps (therapist): (1) Screen spine, joints and balance with particular care (4.1). (2) Refer to a qualified teacher; ask about adaptations for spinal problems. (3) Debrief. The CHQA's English handbook bases the set on twelve traditional routines and describes each step by step with key points, common mistakes and corrections; ask whether the teacher works from it [source: CHQA, Yi Jin Jing (2017), publisher page]. Postures named in one trial protocol include the third posture of Wei Tuo, plucking a star and exchanging the Dipper, nine ghosts drawing swords, bowing, and wagging the tail (tr.) [source: Trials 2021 study protocol, figure 2]. The full list of twelve names is not given here [uncertain].
Example language (illustrative): "This set involves more stretching and twisting of the spine, so let's check with your doctor or physio first given your back."
Watch for: overstretching, pain that persists after class, pushing range to "open" the body. Working: comfortable range, no lasting pain.

4.7 Wu Qin Xi (五禽戏, "Frolics of the Five Animals")

Purpose: a set imitating the tiger, deer, bear, monkey and bird, each associated with a quality such as power, ease, steadiness, dexterity or agility [source: HealthHub Singapore]. Its imitative, playful character may suit clients who find still or inward practice difficult [synthesis].
Steps (therapist): (1) Refer, or teach after instructor training. (2) Discuss the imagery: some clients enjoy the animal qualities; for clients with trauma or dissociation, check that imaginative "becoming" an animal stays playful and eyes-open [synthesis]. (3) Debrief, including which animal qualities felt available or unavailable, as material for therapy [synthesis].
Example language (illustrative): "Which of the animals felt most like you today, and which felt hardest to find?"
Watch for: imitation tipping into absorption or loss of self-awareness; balance problems in the more mobile sequences [synthesis]. Working: client reports enjoyment, energy or steadiness and remains oriented.

4.8 Liu Zi Jue (六字诀, "six-syllable formula" (tr.); sometimes "Six Healing Sounds")

Purpose: described as "the art of expiration in producing six different sounds": breathing and pronunciation paired with simple movements; each of the six sounds can be practised separately [source: HealthHub Singapore]. The tradition links each sound to an organ; that link is attributed, not established [synthesis on attribution]. IHQF-linked instructor training has taught Liu Zi Jue alongside a Health Qigong programme for stress and hypertension [source: JinLi 2016; programme content uncertain].
Steps (therapist): (1) Screen for panic, hyperventilation-related symptoms and respiratory conditions before a breath-focused set [synthesis]. (2) Refer to a qualified teacher; the sounds and breath coordination are taught by the teacher, never from this guide. (3) Do not add breath holds or prolonged breathing patterns; follow the guidance that beginners learn movements before breath [source: The Paper 2023]. (4) Debrief.
Example language (illustrative): "If focusing on the breath or the sounds makes you more anxious, just let the breath be natural and follow the arm movements. That's allowed."
Watch for: light-headedness, tingling, chest tightness or panic during breath work (stop, normal breathing, eyes open) [synthesis]; self-consciousness about making sounds in a group. Working: calm, normal breathing and comfort with the sounds.

4.9 Therapist-led Health Qigong group (Route B only)

Purpose: for a psychotherapist who holds recognised Health Qigong instructor training, to offer the standardised sets as an adjunct group in a mental-health setting [synthesis; training routes in section 1].
Steps: (1) Screen each member individually (4.1, 4.2); obtain written consent covering the nature of the practice, the opt-out, the stop rule and the absence of any treatment claim for physical disease. (2) Open each class by restating the opt-out: anyone may pass, rest or sit at any time [source: UCSF Osher Center practice]. (3) Warm up gently. (4) Teach or practise one standardised set as trained, movements first, breath coordination only later, small range at first [source: The Paper 2023]. (5) Close with a settling activity such as lightly tapping the head or rubbing the ears [source: The Paper 2023], then a short grounding check-in: name, how you feel, anything unusual [synthesis]. (6) Keep eyes-open options, no long still meditation segments, no trance or spontaneous-movement methods [synthesis drawing on Shan 2000]. (7) Keep a log of adverse experiences and follow up anyone who reports one.
Example language (illustrative): "You can sit, rest or skip any movement. If anything feels strange, open your eyes, stand or sit comfortably, and let me know; we stop, we don't push through."
Watch for: a member who becomes still and unresponsive, moves involuntarily, laughs or cries uncontrollably, or speaks of energy, voices or presences; respond per 4.12. Working: members attend, report calm or improved mood, and nobody reports distressing experiences.
Group format note: the sources do not specify group size, course length or session length for psychotherapeutic use [uncertain].

4.10 Brief in-session movement and attention practice

Purpose: to let a trained therapist use one or two simple, slow standardised movements in an individual session as a grounding or bodily-awareness exercise, when the client already attends a class [synthesis; not a published protocol].
Steps: (1) Ask permission; offer standing or seated. (2) Invite the client to show a movement they have learned; join only if the client wishes. (3) Invite attention to feet on the floor, movement and natural breath; no breath control. (4) Stop and talk about what was noticed.
Example language (illustrative): "Would you show me the movement you liked from class? Just notice your feet and your hands as you move. Breathing stays however it is."
Watch for: spacing out, emotional flooding, shame about being watched. Working: client is more present after the movement.

4.11 Integrating class experiences into therapy

Purpose: turn practice into therapeutic material and catch early adverse signs; consistent with Shan's (2000) advice on psychological education after starting.
Steps: (1) After the first classes, ask what happened in body, mood and thought. (2) Name normal experiences and screen for warning signs (4.3). (3) Link to therapy goals: activity scheduling, self-soothing, body awareness, social contact [synthesis]. (4) Explore meaning-making: if the client interprets experiences in qi or spiritual terms, explore respectfully without endorsing or debunking [synthesis]. (5) Review benefit and harm at regular intervals.
Example language (illustrative): "What did you notice during the class, in your body, in your mood, and in your thoughts afterwards?"; "You described it as qi moving. In qigong tradition that's how it's understood. How was it for you: pleasant, neutral, frightening?"
Watch for: escalating preoccupation with energy sensations, practising far more than the teacher advises or being unable to stop (both named by Shan 2000 as risk factors). Working: practice becomes a stable, pleasant routine linked to goals.

4.12 Recognising and responding to qigong deviation (走火入魔, zǒu huǒ rù mó)

Purpose: identify and manage qigong-related psychiatric reactions.
Background: 走火入魔 combines 走火 ("a spark, catching fire" (tr.)) and 入魔 ("being obsessed or possessed" (tr.)); traditional explanations speak of excess heat rising to the head, adverse flow of qi, over-meditation and possession [source: Wikipedia, Zouhuorumo; Shan 2000]. The Chinese Classification of Mental Disorders has listed qigong-induced disorders since 1989; CCMD-2 named "Qigong deviation syndrome" with onset after qigong practice and exclusion of schizophrenia, mood disorders and neurosis [source: Shan 2000; Wikipedia, Zouhuorumo]. The CCMD-3 wording is not given in the sources here [uncertain]. DSM-IV's glossary of culture-bound syndromes included "qi-gong psychotic reaction", defined as an acute, time-limited episode of dissociative, paranoid or other psychotic or non-psychotic symptoms after qigong practice [source: Shan 2000, paraphrased]. Its status as a culture-bound syndrome and the causal link are debated [source: Shan 2000; Wikipedia, Zouhuorumo].
Presentations reported: acute, short episodes often followed by exhaustion and partial or complete amnesia; most commonly an acute psychotic reaction resembling schizophreniform disorder, appearing a few days after practice, with delusions, hallucinations, disorganised speech, elation and holding qigong postures; also depressive or manic pictures, dissociative states with disorientation, and neurotic presentations with a sense of qi moving in the body or rushing to the head, headache, dizziness, hypochondriacal worry, fear of losing control and suicidal ideas [source: Shan 2000]. Others report automatic movements, shaking, panic and paranoia [source: Wikipedia, Zouhuorumo]. In a Shanghai series of 129 people with culture-bound presentations, most had practised alone [source: Shan 2000].
Steps: (1) Ask the client to stop practice. (2) Assess mental state, risk (including suicide risk using your standard approach), orientation, substance use and sleep. (3) Psychotic, manic, severe dissociative or risk features: same-day psychiatric assessment or emergency services; do not attempt to resolve it by more practice. (4) Milder anxiety or somatic sensations: grounding, normal activity, sleep, reassurance, and pause practice until settled; review with teacher and, where needed, the GP or psychiatrist [synthesis]. (5) Once settled, decide jointly whether to stop permanently or resume a gentler set with a teacher, never alone [synthesis drawing on Shan 2000]. (6) Treat persisting conditions with standard evidence-based care; treatments listed in traditional sources (e.g. external qi, acupuncture, herbs) are not substitutes [source on list: Wikipedia, Zouhuorumo; caution synthesis].
Example language (illustrative): "What you're describing can happen after qigong, and the safe thing is to stop for now and get you checked by a doctor today. It isn't your fault, and it usually settles with the right help."
Watch for: the client or teacher reframing symptoms as spiritual breakthrough or possession requiring more practice or a healer; missed bipolar or psychotic illness. Working: symptoms resolve, practice stops or resumes only with a plan.

4.13 Qigong healing and external-qi healing claims

Purpose: respond to clients who seek or receive healing from qigong practitioners, honestly and safely.
Description as practitioners present it: some practitioners claim to treat others by emitting qi (外气, "external qi"), and traditional sources even list external qi among treatments for qigong deviation [source: Wikipedia, Zouhuorumo]. Self-practice forms are also promoted with health claims, such as slowing bone loss and improving immunity [source: HealthHub Singapore].
Evidence status: external-qi healing claims are contested. A systematic review of randomised trials of external qigong for pain (Lee, Pittler and Ernst 2007) called the evidence "encouraging" but called for further studies [source: Qigong Institute abstract]. The existence of an emitted qi as a physical force is a traditional belief, not an established finding [synthesis]. Qigong, internal or external, is not a treatment for cancer or any other physical disease.
Steps: (1) Ask non-judgementally what the client is receiving, from whom, at what cost and with what promises. (2) Give the evidence status plainly. (3) Check that medical treatment continues; if a healer advises stopping medication, discuss urgently and involve the client's doctor. (4) If touch is used, apply 4.14. (5) Respect cultural and spiritual meaning while protecting health.
Example language (illustrative): "Many people find comfort in qigong healing, and I respect that it matters to you. The research on external qi is limited and disputed, and it isn't a treatment for physical illness, so I'd want you to keep your medical care going alongside it."
Watch for: stopped medication, large or escalating fees, promises of cure, isolation from family or doctors, unwanted touch. Working: client keeps medical care and makes informed choices.

4.14 Touch and hands-on correction

Purpose: standardised Health Qigong is self-practice, but teachers may correct posture by touch, and healers may use touch or near-touch.
Steps: (1) Tell clients they may ask that a teacher correct verbally only. (2) Any touch requires explicit consent beforehand and the right to refuse or end it at any time; it must never be sexual. Body-psychotherapy codes state this directly: the USABP Code requires informed consent before touch, the right to refuse or end touch at any time, and holds that genital or other sexual touch is always inappropriate; the EABP Ethics Guidelines require clients to be informed beforehand when physical techniques may be used [source: USABP Code of Ethics; EABP Ethics Guidelines 2020]. Mainstream codes ban sexual contact with clients (e.g. APA Standard 10.05, APA code) without regulating non-sexual touch [source: APA Ethics Code]. (3) A psychotherapist leading a group (4.9) should correct verbally or by demonstration rather than touch [synthesis]. (4) For clients with trauma histories, rehearse saying "please don't touch me" [synthesis].
Example language (illustrative): "You can tell the teacher at the start: 'Please show me or tell me, rather than adjusting me by hand.' That's a reasonable request."
Watch for: freezing when touched, unreported discomfort, boundary violations. Working: client reports feeling in control of physical contact.

4.15 Asahi Health (brief)

Purpose: an alternative for clients wanting a secular, Finnish-developed slow-movement practice drawing on qigong and tai chi, taught by Asahi Health (Helsinki) or Asahi Nordic/Asahi World instructors [source: Wikipedia, Asahi Nordic and Asahi Health].
Steps: apply 4.1–4.4 and 4.11; ask the instructor how they trained (no training curriculum is published in the sources here [uncertain]).
Example language (illustrative): "Asahi is a simple, quiet set of slow movements developed in Finland. Its benefits are mostly claimed rather than tested, but it may be a gentle way to move."
Watch for: the same physical and psychological signs as with qigong. Working: enjoyable, safe routine.

5. Handling problems

The sources say little about problems in a psychotherapy context. Except where a source is named, the guidance below is [synthesis].

Overwhelm, "qi rushing", dizziness or panic during practice: stop, open eyes, sit or walk, breathe normally, name five things in the room; pause practice and review before resuming. Persisting or psychotic features: follow 4.12. Sensations of qi rushing into the head with headache and dizziness are a recognised neurotic presentation in the Chinese literature [source: Shan 2000].
Dissociation or trauma activation: favour Baduanjin or Wu Qin Xi with eyes open and short practice segments chosen with the teacher; avoid long still or inward-focused practice; agree a hand signal or permission to leave; process in therapy. Consider whether stabilisation work should come first.
Client seeks special powers or rapid mastery: these motives are named as risk factors [source: Shan 2000; Wikipedia, Zouhuorumo]. Explore the need behind the goal (control, escape, meaning) and reframe practice as gentle health exercise; if the client persists with intensive or trance-oriented methods, document the risk discussion.
Practising excessively or unable to stop: a risk factor [source: Shan 2000]. Agree limits with the teacher (do not set them yourself), and explore compulsive or avoidant functions of the practice.
Non-adherence or drop-out: explore practical barriers (cost, timing, self-consciousness, pain) and fit; try another set, a seated class or a different teacher; accept that qigong may not suit the client. Do not make therapy contingent on practice.
Resistance on cultural or religious grounds: some clients reject qi concepts as foreign or contrary to their faith; others are offended if they are dismissed. Offer the health-exercise framing without endorsing or debunking beliefs; respect a decision not to practise.
Rupture: client feels pushed or that their tradition is disrespected: acknowledge, ask what felt wrong, return choice to the client. For Chinese clients, explore family and cultural meanings of qigong and of 走火入魔, which may carry stigma or fear.
Physical problems (falls, joint or back pain, dizziness with head turns): stop the movement; the client sees their doctor or physiotherapist; the teacher adapts range or offers seated work. People at risk of falls are advised not to train in standard classes [source: The Paper 2023].
Healer or teacher advising against medical treatment, demanding money for secret levels, or using unwanted touch: treat as a safeguarding and consumer-harm concern; support the client to leave; where a teacher holds a certificate, report to the issuing association; in China, Health Qigong activities fall under the state sports authority's management [source on Chinese administration: The Paper 2021].
Teacher dependence or group pressure: explore idealisation; encourage contact with several teachers or a public class.
Benefit unclear: use your usual outcome measures for mood and anxiety; if no gain after a fair trial, discuss stopping or switching. Remember that the evidence for anxiety is weaker than for depressive symptoms [source: Wang et al. 2013].
Therapist's own competence: without instructor training, do not demonstrate or teach sets; stay in the referral and integration role (UKCP Code item 23; APA Standard 2.01) [source: UKCP Code 2019; APA Ethics Code].

Sources

Web sources:

Works cited as reported by the sources above: American Psychiatric Association, DSM-IV, Glossary of Culture-Bound Syndromes ("qi-gong psychotic reaction") [cited via Shan 2000]; Chinese Society of Psychiatry (1989), CCMD-2 [cited via Shan 2000 and Wikipedia]; 《健身气功管理办法》 (2006) and the 2021 trial rules on exercise-prescription practitioners [cited via The Paper 2021].

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