Blackwell Science, LtdOxford, UKEJCCEuropean Journal of Cancer Care0961-5423Blackwell Publishing Ltd, 2005145457462Original ArticleQi therapy and cancer patientLEE

et al.

Case study

Effects of Qi therapy (external Qigong) on symptoms of

advanced cancer: a single case study
M.S. LEE, phd, Center for Integrative Medicine, Institute of Medical Science, Wonkwang University, Iksan,
S.H. YANG, md, phd, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan,
K.K. LEE, md, phd, Department of Radiation Oncology, Wonkwang University School of Medicine, Iksan, &
S.-R. MOON, md, phd, Center for Integrative Medicine, Institute of Medical Science, Wonkwang University;
Department of Radiation Oncology, Wonkwang University School of Medicine, Iksan, Korea

LEE M.S., YANG S.H., LEE K.K. & MOON S.-R. (2005) European Journal of Cancer Care 14, 457–462
Effects of Qi therapy (external Qigong) on symptoms of advanced cancer: a single case study

The aim of this study was to examine the effectiveness of Qi therapy (external Qigong) in the management
of symptoms of advanced cancer in a man. We used a single case study design to evaluate the effectiveness
of Qi therapy (external Qigong) in a 35-year-old man with advanced cancer (Stage IV) involving metastases in
the stomach, lung and bone (Karnofsky performance scale: KPS, 40: requires special care and assistance,
disabled). Treatment involved six days of pre-assessment, eight treatment sessions on alternate days over
16 days, and a two-week follow-up phase. A visual analogue scale (VAS) was used to assess the patient’s self-
reported symptoms of cancer over the intervention and follow-up periods. Following treatment, VAS scores’
analysis revealed beneficial effects on pain, vomiting, dyspnoea, fatigue, anorexia, insomnia, daily activity and
psychological calmness. These improvements were maintained over the two-week follow-up phase. After the
first Qi therapy session, the patient discontinued medication and could sit by himself; after the fourth session,
the patient was able to walk and use the toilet without assistance (improvement in KPS: 70: care for self,
unable to perform normal activity or to do active work). Although limited by the single case study approach,
our results support previous studies on this topic and provide reasons to conduct controlled clinical trials.

Keywords: Qi therapy, Qigong, cancer, pain, fatigue, dyspnoea, insomnia, vomiting.

I NT RO D U C TIO N parts of the human body. When Qi flows smoothly, all of

life’s processes operate rhythmically and harmoniously.
According to ancient Oriental thought, all humans are
When Qi is weak, unbalanced or blocked, the human
born with self-healing power or energy, called Qi, which
body succumbs to illness and enters a diseased state. Qi
dissipates as we mature. Qi denotes both the essential
practitioners use these basic ideas to measure the ener-
substances of the human body that maintain its vital
getic imbalances in the body, to diagnose disease before
activities and the functional activities of organs and tis-
clinical symptoms appear, and to treat the disease by
sues (Xing 1987). Qi acts extensively by permeating all
normalizing the energetic imbalances. Sustaining Qi
energy is most important to keep the body strong and
healthy.
Correspondence address: Myeong Soo Lee, PhD, Complementary Medi-
There are two methods to refresh or gain this vital
cine, Peninsular Medical School, Universities Exeter & Plymouth, 25
Victoria Park Road, Exeter EX2 4NT, UK (e-mail: drmslee@gmail.com; energy or Qi (Tang 1994). One is Qi training (internal
integmed@chol.com). Qigong), which refers to Qigong practice or to self-
Accepted 3 June 2005 cultivation to achieve optimal health of both the mind
DOI: 10.1111/j.1365-2354.2005.00599.x and body. The other is Qi therapy (external Qigong),
European Journal of Cancer Care, 2005, 14, 457–462 which refers to the process by which Qigong practitioners

© 2005 Blackwell Publishing Ltd

LEE et al.
direct or emit their Qi energy to help patients clear Qi
blockages and move the bad Qi out of the body to relieve
pain, or to balance the Qi flow in the body and help elim-
inate or reduce the effects of disease. Qi therapy helps the
body resist disease by enhancing Qi energy. Qi therapy is
considered more effective when performed by a highly
trained individual (called a master), although simple ill-
nesses such as indigestion, headache, back pain and
fatigue can be treated by someone performed four to six
months of Qi training.
Although neither the Qi therapy itself nor the mecha-
nism of its effects is understandable or explicable within
any paradigm of modern medical science, its effects on the
human body are apparent, as is its effectiveness in many
clinical and psychological illnesses (Lee et al. 2003a).
While much of the research on Qi therapy effects is lim-
ited by methodological flaws, recent randomized con-
trolled trials have found several beneficial effects of Qi
therapy compared to placebo. Two weeks of Qi therapy
significantly reduced the pain level and improved mood in
elderly subjects compared to a general care control group,
but this was not a placebo-controlled study (Lee et al.
2001a). Another recent randomized placebo-controlled
study showed that Qi therapy modulated hormone levels,
and increased immune functions and mood compared to
placebo controls (Lee et al. 2001b). Qi therapy has proved
to be useful in reducing heart rate and stabilizing the sym-
pathetic nervous system (Lee et al. 2003b). Elderly sub-
jects receiving Qi therapy showed a significant decrease in
systolic and diastolic pressure, and reduced anxiety,
depression, pain and fatigue levels compared to placebo
controls (Lee et al. 2003c).
Thus, Qi therapy may have beneficial psychological,
physiological and immunological effects on health. In our
previous study, Qi therapy stabilized cardiac autonomic
tone and the sympathetic nervous system (Lee et al.
2003b), and patients exhibited increased alpha intensity
compared to placebo-treated controls (Lee et al. 2004).
These results showed that Qi therapy helps relax the mind
and body. A relaxed brain produces a reduction in anxiety
and depression, and mood elevation.
Cancer patients experience many negative side effects
of radiotherapy, other pharmacological treatments, and
disease complications. These symptoms can ultimately
influence the patient’s mental health and well-being. Qi
therapy has been reported to be beneficial in reducing
pain, anxiety and fatigue, and in enhancing mood state
(Lee et al. 2001a,b, 2003a,c). Qi therapy is also purported
as an effective treatment of physical and psychological ill-
nesses, including cancer (Chen & Yeung 2002; Lee et al.
2003a). The aim of this study was to examine the effec-
458 © 2005 Blackwell Publishing Ltd, European Journal of Cancer Care, 14, 457–462
tiveness of Qi therapy in the management of symptoms of
advanced cancer in a man.
PAT I ENT AND MET HODS
Research design
The design was a descriptive single case study involving
Qi therapy treatment of a patient with advanced cancer.
Eight Qi therapy intervention sessions were performed on
alternate days over a total period of 16 days. Each inter-
vention lasted 20 min and was performed in the hospital.
The caregiver of this patient rated his symptoms using a
visual analogue scale (VAS), and a nurse recorded his
scores.
The Human Investigation Ethics Committee and the
Human Subjects Review Board of University Hospital and
School of Medicine approved this study and provided
consent for publication of the case history before we
approached the subject and obtained his written consent.
Participant
The study participant was a 36-year-old Korean man with
a graduate degree who worked in a full-time office job. He
had advanced cancer with complications such as diabetes
and hypertension; the primary site of his cancer was the
lung and it had metastasized to the stomach and bone. He
had received radiotherapy and chemotherapy six months
before Qi therapy. At the time of the study, he was being
treated only with opioid therapy for pain (OxyContin C. R.
Tab., 120 mg/day, Mundipharma, UK) and his Karnofsky
Performance Scale (KPS: Schag et al. 1984) was 40
(requires special care and assistance, disabled) over the
previous month. There was no other treatment for his dis-
ease except the medication for pain. Before Qi therapy
began, the patient reported severe symptoms of advanced
cancer, including pain, fatigue, vomiting.
Qi therapy
In this experiment, Korean Qi therapy (called ChunSoo
Energy Healing) was performed by a Qi therapist in Ki
Health International. The Qi master was a male, 32 years
old, who had practised ChunDoSunBup Qi training for
6 years. Qi therapy was administered according to the
standard procedures outlined in the textbook for Qi ther-
apy (Ki Health International 1997), but slightly modified
for this patient. The Qi master followed the experimental
schedules and attempted to emit Qi with positive think-
ing to restore harmony and balance to the patient’s energy
systems. The participant received attention for about
 Qi therapy and cancer patient

Table 1. Description and illustration for each step of Qi therapy

Step Illustration Description
1 The Qi master centres him/herself, making a conscious effort to help the subject while becoming
mentally aware of self as one with the cosmos.

2 The Qi master moves his/her hand about 3–10 cm from the subject’s body in a pattern from head
to toe, becoming aware of changes in sensory cues in the hands.

3 The Qi master redirects areas of accumulated tension in the subject’s body by emitting Qi from
the hand.

4 The Qi master concentrates his/her attention on the specific direction of energy flow (sensory
cues), finishing by holding the subject’s feet.

5 Subject turns over and receives the same procedure for 10 min on the other side of the body.

20 min according to described procedures in the following
sequence (Table 1).
Outcome measures
The VAS was used to assess the patient’s physical symp-
toms of cancer such as pain, vomiting, dyspnoea, fatigue,
insomnia, and anorexia, daily activity and psychological
calmness during the 24 h before each assessment. At each
assessment, the subject was not informed of his previous
scores.
The VAS for physical symptoms ranged from 0, which
represents an absence of symptoms, to 10, which repre-
sents an extreme level of symptoms (Fig. 1). The scale was
reversed to assess daily activity and calmness (i.e. 0 rep-
resents the lowest level of activity and calmness, and 10
represents the highest level of activity and calmness). The
VAS numerical scale is a commonly used method to assess
symptoms with established reliability and validity (Cline
et al. 1992; Dudgeon et al. 2001).
Data representation
Results are presented in graphic form for visual analysis,
which is the traditional way to evaluate single case stud-
ies. Statistical analysis has not been applied to the data
because there is little consensus as to whether inferential
analysis is appropriate when evaluating single case stud-
ies. In addition, when a treatment effect is clearly discern-
ible, visual inspection alone is considered appropriate.
The graphs allow visual analysis of the change in levels of
pain, vomiting, dyspnoea, fatigue, anorexia, insomnia,
daily activity and psychological calmness between the
pre-treatment, treatment and follow-up phases.
R ESULT S
In the pre-treatment assessment phase, the patient
reported extremely high levels of pain, and was treated
with 120 mg/day OxyContin. The pain score decreased
slightly after the first Qi therapy session (Fig. 2A), and the
patient discontinued taking OxyContin. The pain level
decreased further after the fourth Qi therapy session (day
8), and slightly increased at the end of the 16 days of Qi
therapy; the pain score remained at this level after the
two-week follow-up.
The vomiting score decreased slightly after the first and
increased after the second Qi therapy session (day 4), but
then rapidly improved from the third Qi therapy session
(day 6); the patient reported no vomiting after the fifth Qi
therapy session (day 10) through the two-week follow-up
(Fig. 2B). The dyspnoea score rapidly decreased from the

© 2005 Blackwell Publishing Ltd, European Journal of Cancer Care, 14, 457–462 459
LEE et al.
Physical
symptoms 0 1 2 3 4 5 6 7 8 9 10
Absence Extreme
level
Activity or
calmness
0 1 2 3 4 5 6 7 8 9 10
Lowest Highest
level level
Figure 1. Typical example of visual analogue scale (VAS) used in
this study: (A) VAS for physical symptoms of cancer such as pain,
vomiting, dyspnoea, fatigue, insomnia and anorexia (B) VAS for
daily activity and calmness.
first to the fourth Qi therapy sessions (day 8), increased
slightly, and then remained constant through the two-
week follow-up (Fig. 2C). The fatigue score steadily
decreased throughout the 16 days of Qi therapy (Fig. 2D).
There was a slight increase after the last therapy session,
after which the fatigue score remained constant through
the two-week follow-up.
In the pre-treatment phase, the patient reported anor-
exia because of pain, vomiting and fatigue. The anorexia
score decreased rapidly after the second Qi therapy session
(day 4) and remained at this level until the end of the two-
week follow-up (Fig. 2E). In the pre-treatment phase, the
patient reported severe insomnia and an inability to sleep
well. After the second Qi therapy session (day 4), the
insomnia score rapidly decreased and remained stable
throughout the 16 days of treatment and during the two-
week follow-up (Fig. 2F).
The patient reported zero daily activity in the pre-
treatment phase (i.e. he found movement difficult and
remained in bed all day, KPS: 40). His activity score
increased after the second Qi therapy session (day 4), when
he was able to sit in bed for one-half day without help
(KPS: 60: requires occasional assistance but is able to care
for most of own needs). After the fourth Qi therapy ses-
sion (day 8, KPS: 70, care for self, unable to perform nor-
mal activity or to do active work), the patient could walk
and use the toilet without help; he maintained this level
of activity through the two-week follow-up (Fig. 2G). The
score for psychological calmness increased (i.e. improved)
after the second Qi therapy session (day 4). He reported
‘peace of mind’ after the fourth Qi therapy session; this
score remained at this level through the two-week follow-
up (Fig. 2H).
DI SC U SSIO N
Qi therapy (external Qigong) treatment was associated
with beneficial effects on the patient’s self-rating of pain,
460 © 2005 Blackwell Publishing Ltd, European Journal of Cancer Care, 14, 457–462
vomiting, dyspnoea, fatigue, anorexia, insomnia, daily
activity and psychological calmness. These variables
improved from baseline (pre-intervention) measures, and
improvements were maintained for two weeks after the
end of treatment. The chronic nature of the patient’s dis-
ease indicates that spontaneous remission cannot explain
the improvements during and for two weeks after the
intervention.
The patient discontinued using pain-killing medication
and was able to sit without help after the second Qi ther-
apy session. After a further two sessions (i.e. after the
fourth session), he was able to use the toilet without help
and to walk alone near the hospital. Our recent report
shows that a single session of Qi therapy can influence
psychological symptoms and pain in cancer patients (Lee
& Jang 2005). Accumulation of these acute effects over
time might be responsible for the improvements in symp-
toms reported by this patient. Our previous reports show
that Qi therapy modulates psychological, neurohormonal
and immunological functions, as assessed using both in
vivo and in vitro methods (Lee et al. 2001a,b, 2003c,d,
2004). In our current study, the patient’s symptoms might
have been alleviated because the Qi therapy stimulated a
holistic connection of body function with mind.
Through his written responses, the patient reported an
effect of Qi therapy on his feelings of ‘inner peace’. He
reported experiencing ‘relaxation of mind and emotions’
and the energetic power of Qi, which he felt provided him
with the strength to overcome pain and fatigue. Qi ther-
apy is believed to help the body resist disease by enhanc-
ing the body’s Qi and energy. However, we acknowledge
that administering Qi therapy requires specialist training
and is not therefore currently broadly generalizable. We
cannot also completely discount the possible bias of date
rating, even if the data were collected from the caregiver
and recorded by a nurse.
CONCLUSI ONS
Despite an increased demand for non-pharmacological,
complementary therapies such as Qi therapy and mas-
sage, continued scientific research on the therapeutic
benefits of Qi therapy is needed to fully understand its
possible role in health and well-being. Although our data
may not be generalized to other patients with cancer or
other diseases, this case study provides a foundation for
further research exploring the ability of complementary
therapies such as Qi therapy to reduce or prevent the
negative symptoms of cancer. More objective clinical
measures are needed in addition to the self-reported
 Qi therapy and cancer patient

A B
10 Post 10 QT Post
Pre QT Pre

8 8

6 6

4 4

2 2

0 0

–6 –4 –2 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 –6 –4 –2 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30
Days Days

C D
10 Post 10 QT Post
Pre QT Pre

8 8

6 6

4 4

2 2

0 0

–6 –4 –2 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 –6 –4 –2 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30
Days Days

E F
10 10 QT Post
Pre QT Post Pre

8 8

6 6

4 4

2 2

0 0

–6 –4 –2 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 –6 –4 –2 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30
Days Days

G H
10 QT Post 100
Pre Pre QT Post

8 80

6 60

4 40

Figure 2. Effects of Qi therapy on visual 2 20

analogue scale scores for (A) pain (B) vom-
iting (C) dyspnoea (D) fatigue (E) anorexia 0 0
(F) insomnia (G) daily activity and (H) psy-
chological calmness. Pre, pre-treatment; –6 –4 –2 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 –6 –4 –2 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30

QT, Qi therapy; Post, post-treatment. Days Days

improvements we found using the VAS. In future studies, ACK NOWLEDGEMENT

we intend to use well-controlled clinical trials to mea-
sure the efficacy of Qi therapy, to perform detailed phys- We specially thank Master Soo Hwan Hong, Sang-Hak Ki
ical examinations, and to include a greater number of Health International, Jeonju, Korea for his technical
cancer patients. assistance.

© 2005 Blackwell Publishing Ltd, European Journal of Cancer Care, 14, 457–462 461
LEE et al.
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