Introduction to Alternative Medicine Therapies in Health Care
Unconventional therapies are frequently referred to as either complementary or alternative medicine therapies. Complementary therapies are those therapies used in addition to conventional treatment recommended by the person’s health care provider. Alternative therapies are those therapies that frequently become the primary treatment that replaces allopathic medical care. They vary in degree to which they are compatible with allopathic medicine. They base interventions on conventional pathophysiology, anatomy, and kinesiology but at the same time, explore mind-body connections that may cause or contribute to the psychological condition.
Between one third and one half of the population in the United States uses one or more forms of complementary or alternative medicine (2000). Furthermore, data from a recent survey of U.S. citizens suggest a 47.3 % increase in the number of visits to alternative medicine practitioners ( 2004). This exceeds the number of visits to allopathic medicine practitioners.
Because of this increased interest and use of complementary and alternative medicine, many institutions, including some mainstream medical schools, have established training programs that incorporate complementary and alternative medicine philosophy and content into the curriculum. The interest in complementary and alternative medicine is also evidenced by the increased number of articles about it in respected medical journals and the development of several journals that specifically focus on complementary and alternative medicine. Many clinics also incorporate complementary and alternative medicine in their list of services. For this paper, the practice of Tai Chi and its increasing incorporation in clinics will be discussed.
Tai Chi
Taijiquan, also known as Tai Chi (pronounced tie CHEE), is an ancient form of Chinese martial arts. Tai chi is a manipulative and body-based method of alternative therapy. It’s often referred to as meditation in motion, as it calls for slow, rhythmic movements requiring balance and concentration. It is an ancient practice of body movement and poses that is conducive to flow of energy, to improving strength and health, to mobility and to stress relief — resulting in a sense of calm and peace. It is a technique that incorporates breath, movement, and meditation to cleanse, strengthen, and circulate vital life energy and blood. It is a therapy used to stimulate immune system and maintain external and internal balance. It also involves stretching and boxing activity that enjoys great popularity in China and many other nations. Originally an Eastern practice, Tai Chi migrated to the West and now is taught and practiced in cities around the world. It is becoming increasingly popular with people of all ages in the United States. Tai chi is renowned for its meditative and health benefits when practiced daily (1995).
History of Tai Chi
Many theories exist about the origin of Tai Chi. Two theories though merit mention regarding the origins of Tai Chi.
Tai Chi Chuan is said to have its origins during the thirteenth century. It is claimed that Chang San-Feng is the founder of Tai Chi Chuan. Chang gave up a prestigious government position and his worldly possessions to wander the mountains of China in search of truth and wisdom. He visited the Shao Lin Buddhist temple where the monks practiced boxing to give them the physical strength to pursue a life of soul development. Dissatisfied with the Shao-Lin martial art which used excessive force and physical strength, Chang developed Tai Chi Chuan which is soft and gentle. Chang was inspired by the concept of softness overcoming firmness when he observed how a magpie’s attempts to attack a serpent were thwarted by the serpent’s soft motions (1995).
It has also been documented that Tai Chi was originally created in Henan Province about 300 years ago, during the late Ming and early Qing dynasties. Instead of focusing on quick, powerful, and vigorous movements for self-defense or attacking actions like those in other martial arts, Tai Chi emphasized graceful skills and movement patterns. In the ensuing 300 years, Tai Chi has experienced a significant evolution not only in its variety of styles, but also in its unique contributions to health and fitness (1995). Though Tai Chi Chuan existed in the thirteenth century, it was exclusive only to families that used it for sparring.
Currently, Tai Chi Chuan has become a common practice for many people in Asia and the Chinese-American communities of California. Tai Chi chuan is practiced predominantly for health reasons. While it improves circulation, coordination, reduces stress, and strengthens muscles, it can also be used for self-defense. Tai Chi Chuan is also touted to slow down the aging process (1995). Westerners are slowly realizing the potential such scripted moves have for health, especially when integrated into a program that includes aerobic exercise and strength training (2004).
Holistic alternative medicine in the present times
In holistic theory, all living organisms are seen as interacting, unified wholes that are more than the mere sum of their parts. Viewed in this light, any disturbance in one part is a disturbance of the whole system; in other words, the disturbance affects the whole being. Thus, the nurse must keep the whole person in mind when assessing one part of an individual and consider how that part relates to all others. The nurse must also consider how the individual interacts with and relates to the external environment and to others.
Holistic theories maintain that health requires that the forces of nature be kept in balance or harmony. Illness results when the natural balance or harmony is disturbed. Many cultures have held the holistic belief view for centuries. Holistic health, then involves the total person: the whole of the person’s being and the overall quality of lifestyle. The complementary and alternative medicine is only one part of the practice of holistic nursing (2004).
Although nurses have always been concerned with the whole person, they are increasingly embracing ideas about health and healing that are very different from those that inform the health care delivery system. Conceptualizations of health, disease, pain, and death vary widely from one culture to another. The same is true for therapies or practices designed to promote health, cure disease, ease pain and suffering, and give meaning and dignity to death. Nurses are progressively incorporating ideas and therapies from other cultures and traditions into their practice. These therapies are numerous and one of them is Tai Chi. Thus, the practice of Tai Chi is still a part of holistic nursing.
Background, experience, and knowledge to become a healer today
In order for one to become a healer, there are many things that are needed. In professional health care practice, to become a healer needs rigorous education and training in a specific field. In alternative medicine however, no formal education is offered in the field. And thus, there needs to be some form of informal education so as for the healer to be adept at what he or she does. Background, experience, and knowledge in the practice of Tai Chi is therefore important. One can not just trust anyone to provide services on the practice of Tai Chi. The coordination of movements in Tai Chi has to be perfectly done so as to achieve the benefits of the practice.
What world view do the masters see guiding their practice today?
Practiced for centuries by Chinese monks greeting the rising sun, tai chi has been used for defense, meditation and therapy. Although Chinese medicine has been considered an “alternative” (therefore, unscientific) practice, the martial art Tai Chi Chuan or “The Grand Ultimate Fist,” has improved the physical conditions and well-being of many individuals. Tai chi offers relaxation techniques combined with healing aerobic movements (2002).
Tai Chi is based on the Chinese thought that there exists in the body a “chi” a vital force that animates the body. It is the center of a person’s energy. Acupuncture is also based on this idea. Tai Chi has circular movements believed to circulate energy through the body in patterns almost identical to the vascular and nervous system ( 2005). This is the guiding practice that masters in Tai Chi follow. Masters in the field of Tai Chi believe that it embodies Taoist Philosophy, and accordingly is extremely beneficial to good health.
What are some examples they use to evaluate the effectiveness of their approach?
Modern scientific medicine has numerous strengths, including a preference for evidence-based practice. (2000) argues that a major shortcoming of scientific medicine is an “inadequate appreciation of cultural diversity in determining the efficacy of health care.”
However, the use of Tai Chi as an alternative medicine is evidence-based. Numerous studies and researches on the use of Tai Chi and its effects have been well documented. The results of these studies and researches were used to evaluate the effectiveness of the use of Tai Chi. Unlike forms of martial arts that require explosive kicks or jumps, there are no jerky movements in Tai Chi. An individual won’t even huff and puff while doing it. This is not aerobic exercise. Despite that, nearly two decades of research reported in Western medical journals indicates that practicing this ancient art may offer numerous health benefits, especially as you age (2004). Below is a table that presents some studies regarding the use of Tai Chi and the different benefits that could probably be gained by the use of Tai Chi.
Table: Some Randomized Controlled Trials of Tai Chi practice
Study
Outcome
No. of subjects
Mean age or range
Style and duration
Main conclusions
Wolf et al., 1996, United States
Balance and falls
200
76 years
15 weeks, twice per week, 108 forms of Yang style
Reduced risk of multiple falls, reduced blood pressure
Jacobson et al., 1997, United States
Balance, strength, flexibility
24
20-45 years
12 weeks, 3 times per week, 108 forms of yang style
Improved balance, function, and strength
Li et al., 2001(a), Unites States
Physical functioning
94
73 years
6 months, twice per week, classical Yang
Enhanced self-efficacy and functional status of physically inactive adults
Hartman et al., 2000, United States
Various aspects of arthritis
33
68 years
12 weeks, twice per week, 9 forms of Yang style
Enhanced self-efficacy, quality of life, and functional mobility
Young et al., 1999, United States
Impact on hypertension
62
69 to 80 years
12 weeks, twice per week, Yang style
Decreased blood pressure
Channer et al., 1996, United States
Impact on hypertension
126
56 years
8 weeks, twice per week for three weeks, Wu style short form
Decreased blood pressure
Li et al., 2001(b), United States
Psychological measures
148
73 years
6 months, once per week, classical Yang style
Reduced depression and psychological distress; enhanced well-being and life satisfaction
Brown et al., 1995, united States
Psychological measures
135
51 years
16 weeks, 3 times per week, style not identified
No significant difference among treatment groups on measures of mood, self-esteem, or life satisfaction
Baron, 1998, Canada
Psychological measures
90
Children, grades 4-6
12 weeks, twice per week, Yang style
Improved self-competence and visual motor integration
2004
The randomized trials reflected in the above table collectively suggested that Tai Chi might be useful in reducing risk of falls, improving balance, improving quality of life and functional capacity among arthritis sufferers, and perhaps even enhancing cardiovascular function.
Tai chi exercise may even slow the loss of mental functioning in the elderly. In one study, patients practicing tai chi who later developed Alzheimer’s disease and senile dementia functioned at a higher level than those who did not practice Tai Chi. Tai Chi may also enhance activity of the endocrine, reproductive and immune systems. Those who practiced tai chi had higher levels of testosterone, cortisol, follicle stimulating hormone, lutenizing hormone and thyroid hormone. In addition, they also had an increase in immune system T cells. T cells kill bacteria and viruses and are also involved in the recognition and destruction of cancer cells (2004).
But all the randomized trials on Tai Chi have been short, lasting only 8-16 weeks. Therefore long-term effects of Tai Chi practice are still unknown, and there is insufficient information to recommend Tai Chi to patients with chronic conditions (2004).
What are the processes commonly used in this healing art?
The Chinese philosophy of Tai Chi revolves around “qi” (an alternative spelling of chi), which means breath or life or energy. The Tai Chi philosophy is based on the belief that the body’s life “energy” is maximized when it is kept circulating. Tai Chi movements are designed to open the body’s “energy channels” by integrating the physical and spiritual aspects of a person, much as yoga does. Yoga, originating in India, also involves meditation and body postures ( 2004).
A variety of styles or schools of Tai Chi have evolved over time, reflecting both growth and development of the form in general as well as differences of style between different teachers. Elements from other martial arts forms have influenced Tai Chi and this has changed its character as well. Most of the different styles or schools of Tai Chi have been given the surnames of their founders. There are many styles of Tai Chi that exist today, the most popular being: (1) Yang Style, (2) Chen Style, (3) Sun Style, and (4) Wu Style ( 2006). The yang style, the root style, can be divided into the long form and the short form. The long form has 108 forms and the short form has 48 forms. During World War II the short form was developed for the military so the pilots could center their mind before a mission ( 2005).
Traditionally, there are eight to 13 Tai Chi postures, with names like “Needle at the Sea Bottom” or “Grasp Sparrow’s Tail,” among others. Modern Tai Chi uses many other postures, but focuses on these basic movements, which emphasize balance and coordination, while building strength in the lower body. The instructor teaches how to focus on posture, body alignment and breathing, so the student maintains awareness of the whole body while moving into each posture (2004).
There are also two principles that have to incorporated into the practice of Tai Chi. The two most important principles in performing Tai Chi are relaxation and stillness. Relaxation helps keep the body feeling natural, and the movements mild, gentle and coherent–with no strong force. Stillness allows the mind to concentrate and reach serenity (1992).
What outcomes do they see that they meet?
People practice Tai Chi for a number of reasons, including the fact that based on evidence-based practice they have outcomes that they want to meet. Generally, the objectives are to improve fitness, ensure physiological and psychological well-being, and enjoy mastering the techniques. Participants can benefit from the practice without having a “perfect” Tai Chi performance. Instead of strictly focusing on the “ideal” movements, instructors of Tai Chi can emphasize having fun and feeling good during practice (1995).
Anyone can benefit from Tai Chi-like most low-impact exercises, it can be an important part of a healthy lifestyle. Tai Chi isn’t a treatment or a cure, but health care professionals often suggest it as a complementary therapy for many conditions. Few randomized controlled studies (the scientific standard for determining treatment efficacy) have so far been conducted to establish the direct medical benefits of Tai Chi, however, although some preliminary studies suggest that Tai Chi can help relieve the symptoms of or prevent certain conditions ( 2006).
Many of the outcomes that Tai Chi practitioners wish to attain are basically reflected in evidence-based benefits of studies involving the use of Tai Chi. Tai Chi is considered useful in:
- Reducing the risk of falls in the elderly by improving balance and strength as well as confidence
- Improving cardiopulmonary function and cardiovascular fitness
- Reducing blood pressure
- Reducing stress, reducing the amount of stress hormones in the body, and enhancing body awareness
- Helping to strengthen the muscles around an arthritic joint, improving and increasing flexibility and range of motion while reducing joint pain. Stronger muscles also help protect the joint from soft tissue injuries
- Easing back pain by improving flexibility. Plus, it helps maintain or improve both upper-body and lower-body strength
- Slowing the decline in respiratory function, often a concern among the elderly. Plus, the regular exercise afforded by the practice–comparable to a moderate aerobic workout–provides cardiorespiratory conditioning
- Stimulating circulation, improving blood flow to the extremities and its return to the heart
- Helping speed and aid recovery after a heart attack. Tai Chi is sometimes used as an adjunct therapy in cardiac rehabilitation. One reason for its benefit may be its ability to reduce blood pressure and heart rate
- Helping people with multiple sclerosis increase their physical activity/functioning by enhancing muscle tone, flexibility, coordination and general well being. As a result, some chapters of the National Multiple Sclerosis Society now offer Tai Chi classes
- Helping to slow or prevent bone loss since it’s a weight-bearing exercise
- Improving posture, coordination and agility as well as improving walking gait and reducing shuffling
What are their expectations?
The American concept of martial arts, shaped through movies and TV shows, suggests a pugilistic art only for self-defense. That concept is incomplete. The popular “Bruce Lee” conception of “hard fist” kung-fu tends to stress tense, fast moves, great physical exertion and fierce competition. The opposite end of the spectrum is tai chi chuan, the “soft fist” method ( 1992). Tai chi is thus utterly different from the better known martial arts in this country. Most often, some individuals have another view and expectation of Tai Chi considering that it is some form of martial arts. But once the confusion gets resolved, individuals only have to expect benefits from the practice of Tai Chi.
For older people at risk of breaking osteoporosis-weakened bones, Tai Chi offers a way to build muscle strength and improve balance and body awareness. This could prove to be as important as lifting weights and nutrition in preventing the sometimes devastating consequences of osteoporosis ( 2004).
Tai Chi involves controlling the body, adjusting posture, and maintaining balance during shifts in the body’s center of gravity from single leg stances to dual leg stances at a smooth and slow movement speed. Doing the exercises involves progressively using movements that flex the arms and knees while rotating the trunk, head, and extremities to facilitate increased functioning and reduce the risk of falling. Tai Chi promotes confidence in movement by reducing side-to-side movement (sway) in anterior and posterior directions and increases postural stability, thereby reducing the risk of falls (2005).
Do they have various alternative practices within the main tradition?
There are several reasons that Tai Chi practitioners experience health and fitness benefits. First, participants concentrate very hard on their performance, thereby excluding external distractions and generating a sense of internal peacefulness. Second, the motion of Tai Chi is slow, smooth, and graceful, which facilitates mental and muscular relaxation while increasing range of motion. In connection with these, various alternative practices are developed still with the same principles found in Tai Chi.
In one study by (2000), a modified version of tai chi, the tai chi c’hih was tested as an approach to health promotion in populations with chronic illness and older adults. Tai chi c’hih is a form of exercise consisting of a series of slow balanced movements and breathing. The purpose of the study was to determine the energy cost of tai chi c’hih. This is to assist in the planning of a safe and effective exercise prescription for clients with very low energy reserves. The results of the study indicated that the energy requirements for this alternative form of exercise was comparable with low-level exercises for persons with low exercise tolerance. Tai chi c’hih thus promotes feelings of relaxation and increased energy, making it an ideal alternative exercise prescription for clients with chronic illness.
What information do they feel is important to give to patients who seek their needs?
The effectiveness of Tai Chi Chuan as a healing and martial art is due to the synchronization of abdominal breathing with the movements of the head, torso, limbs and hands. The slow and gentle movements are empowered by the inner energy in the lower abdomen. These movements in turn facilitate the generation of more inner energy. After several years of consistent Tai Chi Chuan, the practitioner manifests an energy which is perceived as great strength ( 1995).
Patients who want to undergo Tai Chi or who are advised to practice Tai Chi should be informed of the mechanism of process of this alternative form of medicine. It should be emphasized to patients that Tai Chi chuan, or t’ai chi, is a physical conditioning exercise that enhances the flexibility of body movement. The slow, graceful, elegant gestures of tai chi chuan routines hardly resemble the original hand and foot blows and blocks and parries they represent. So patients should not worry of over exertion which is what would probably happen in other martial arts exercises. Patients should also be informed that there is little likelihood that Tai Chi could be used for practical, modern self-defense. If patients seek to learn self-defense, then Tai Chi is not the one for them.
What needs to be researched?
As is previously mentioned, most, if not all, the randomized trials on Tai Chi have been short, lasting only on average 8-16 weeks. Thus the long-term effects of Tai Chi practice are still unknown, and there is insufficient information to recommend Tai Chi to patients with chronic conditions. Further research has therefore to be done on the long-term effects of Tai Chi on individuals who have chronic conditions.
Furthermore, although Tai Chi has been practiced in China and in some parts abroad for many years, there is still very limited scientific evidence concerning its physiological and psychological benefits. In recent years, scholars from both the East and the West have examined the influence of Tai Chi in laboratory settings. The results have been mixed (1995), prompting a need for further research on this area.
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