THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE

Volume 10, Number 3, 2004, pp. 456462

Mary Ann Liebert, Inc.

Effects of Qi Therapy (External Qigong) on Premenstrual

Syndrome: A Randomized Placebo-Controlled Study
HYE-SOOK JANG, R.N., Ph.D.,1 and MYEONG SOO LEE, Ph.D.2,3

ABSTRACT
Objectives: To assess the effects of qi therapy on premenstrual symptoms in women with premenstrual syndrome (PMS).
Design: A randomized placebo-controlled trial.
Subjects: Thirty-six (36) college women with symptoms of PMS.
Intervention: After 2 months of screening, subjects with PMS were randomized to receive real qi therapy
(18 subjects) or placebo (18 subjects). The subjects were informed that they would receive one of two types of
treatment. They did not know which treatment they received. Each intervention was performed eight times during the second and third cycles with subjects completing a PMS diary.
Results: There were significant improvements in the symptoms of negative feeling, pain, water retention,
and total PMS symptoms in subjects receiving qi therapy compared to placebo controls.
Conclusion: Qi therapy may be an effective complementary therapy for managing the symptoms of PMS.

INTRODUCTION
etrospective community surveys estimate that some
30%90% of women have suffered from premenstrual
symptoms (Chung et al., 1996; Jeong et al., 2001; Lee et al.,
1994) and 82.6% of college-educated women in Korea have
experienced painful premenstrual symptoms (Han and Huh,
1999). Premenstrual syndrome (PMS) is characterized by a
spectrum of physical and mood symptoms, which appear
during the week before menstruation and usually resolve
within a week after the onset of menses. Most women in
their reproductive years experience some premenstrual
symptoms. Thus, the management of PMS is important for
womens health. However, there is considerable debate regarding the nature and extent of PMS symptoms. This has
resulted in an ongoing search for explanatory theories, each
of which has stimulated the evaluation of new treatments.

Common pharmacologic treatments include the use of

natural progesterone and synthetic progestins, diuretics for
edema, antiprostaglandins, bromocriptine, a dopamine receptor agonist, and pyridoxine, a water-soluble B vitamin
for PMS (Magos, 1990; Michener et al., 1999; OBrien and
Abukhalil, 1999; Robinson et al., 1977; Wyatt et al., 1999).
Nonpharmacologic interventions such as cognitive therapy, relaxation responses, reflexology, and massage therapy
result in effective PMS control (Blake, et al., 1998; Goodale
et al., 1990; Hernandez-Reif et al., 2000; Oleson and Flocco,
1993). While pharmacologic treatments are, appropriately,
the central component of PMS therapy, the underutilization
of effective nonpharmacologic strategies (NPS) may contribute to the problem of PMS among reproductive women.
According to ancient Chinese thought, qi denotes essential substances of the human body that maintain its vital activities, and the functional activities of organs and tissues

1Department

of Nursing, Wonkwang Health Science College, Iksan, Korea.

Graduate School of Oriental Medicine and 3Center for Integrative Medicine, Institute of Medical Science, Wonkwang
University, Iksan, Korea.
2Professional

456

EXTERNAL QI THERAPY REDUCES PMS

(Xinnong, 1987; Shin, 2002). Qi is commonly viewed as vital energy or the life force, and is the source of vitality and
strength. Qi acts extensively in the human body by permeating all parts. The meridians in the body are the main pathways through which qi, or life force energy, moves and
flows. In fact, all of nature, including humanity, is dependent on this vital force. When qi flows smoothly, all of lifes
processes operate rhythmically and harmoniously. If qi is
weak, unbalanced, and blocked, the human body succumbs
to illness and enters a diseased state. Ultimately, the cause
of all disease derives from energetic imbalances. A practical extension of these basic ideas is to diagnose the disease
before it manifests in the physical body by measuring the
energetic imbalances, and to treat the disease (with energy)
by normalizing the energetic imbalances. Therefore, sustaining qi energy is more important than anything else in order to keep the body strong and healthy.
Medical qigong has been used as a traditional complementary intervention to prevent and cure disease, to improve
health, and to strengthen the vital energy through practice
or by receiving it from practitioners (Chen and Yeung, 2002;
Lin and Chen, 2002). It is divided into two kinds: internal
and external qigong. Internal qi training refers to qigong
practice or to cultivation by oneself to achieve optimal health
for both mind and body. External qi therapy refers to the
process by which qigong practitioners direct or emit their qi
energy with the specific intention of helping patients clear
qi blockages and move the bad qi out of the body so as to
relieve pain, or to balance the qi flow in the body and get
rid of diseases. Accordingly, external qi therapy may be
helpful in rectifying qi deficiency and eliminating blockages
and stagnation.
Although neither the qi therapy itself nor the mechanism
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 psychologic illnesses (Lee et al., 2003a). While much
of the research on qi therapy effects is limited by methodological flaws, recent randomized controlled 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 placebocontrolled 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 sympathetic nervous system (Lee et al.,
2003b). Elderly subjects 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 psychologic, physiologic, and immunologic effects on health. In our previ-

457
ous 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. This is consistent with reduced
levels of cortisol, heart rate, and blood pressure (Lee et al.,
2001b, 2003b, 2003c). One of the interesting features of
qi therapy is that the qi-receiver feels a rapid renewal of
energy or reduced fatigue levels (Lee et al., 2003c). Another feature is that qi experts can direct qi flow to any part
of the patients body to relieve stress and pain. Higuchi
et al. (2001) reported that the adrenaline and noradrenaline levels of qi receivers significantly decreased, and their

-endorphin levels slightly increased at 40 minutes after qi
therapy. Qi therapy may also enhance the delivery of painkilling substances such as endorphins or drugs to control
pain (Sancier and Hole, 2001).
Recent in vitro studies (Lee et al., 2001c, 2003d; Yu et
al., 2003) show that emitted qi or the masters intention affects the activity of natural killer cells, neutrophil function,
and human prostate cancer in a positive manner. In addition, it may be possible to store information about emitted
qi in media used for cell culture (Fukushima et al., 2001).
In the field of biophysics, many attempts have been made
to verify the process of distant or spiritual healing and the
existence of emitted qi. Some authors have proposed nonlocalized quantum energy, and holoenergetic quantum consciousness theories (Gough 1999; Rein, 1992, 1998, 2004).
Such theories may provide guidance for maintaining the intercellular communication processes that are essential for
human growth and health. In addition, a functional role of
biofields (endogenous energy fields of the body) in the
bodys innate self-healing mechanisms has been hypothesized, based on the concept of bioinformation. This, mediated by consciousness, is supposed to function globally at a
molecular quantum level to supply coherence, phase, spin,
and pattern information to regulate and heal physiological
processes (Rein, 1992, 2004). The intercellular communication between healer and receiver, or in the healing of oneself, is thought to be involved in increasing coherence between cells (Gough 1999; Rein, 1992, 1998; Sancier and
Hole, 2001). However, the true mechanism requires further
study.
From the perspective of Oriental medicine, the symptoms
of PMS are principally ascribed to impeded flow of qi and
blood in the uterus (Xinnong, 1987). Deficiency or stagnation of qi and blood may cause irregular menstrual flow,
disharmony between qi and blood, and injury of the meridians. If it is possible to remove the blockage, stagnation, deficiency, and imbalance of qi, this may alleviate symptoms
of PMS. Thus, the purpose of this study was to investigate
the effects of qi therapy in college students with PMS compared to a placebo control group.

458

JANG ET AL.

MATERIALS AND METHODS

Subjects
Volunteers were recruited for the study from Wonkwang
Health Science College in Iksan, Korea. One hundred and
fourteen (114) received Menstrual Distress Questionnaires
(MDQ; Moos, 1968) and 83 (72.8%) completed them. The
selection criteria for each subject were as follows: (1)
marked disruption of work, school, or social activities and
relationships; (2) regular menstrual cycles; (3) no oral contraceptive use; (4) no past or present diagnosis of psychiatric, internal, or obstetric illness; (5) no history of practicing a relaxation-responding technique within the past 6
months; (6) no current prescription medication use or any
other therapy for PMS; (7) no habitual smoking or drinking; and (8) at least two severe symptoms of PMS from a
list of eight premenstrual symptoms (pain, concentration
lapses, behavioral changes, changes in autonomic nervous
system reactions, water retention, negative feeling, and
changes in arousal and self-control). Subjects who failed to
meet each of these criteria were excluded from the study.
Of the 114 subjects who were originally screened, 51 entered the initial phase of the study. Before admission into
the study, the potential subjects underwent a pretreatment
assessment of symptoms over two successive cycles to confirm a diagnosis of PMS. Of the 51 potential subjects, 15
were excluded before they received any intervention, leaving 36 subjects who completed the study. Reasons for exclusion included: no PMS symptoms in the next cycle (2),
did not complete the PMS diary (4), were too busy or working (5), and wanted to quit (4). The remaining subjects completed a full round of treatments. They were asked to attend
their scheduled intervention and were telephoned routinely
before intervention by four assistants who checked that they
adhered to the schedule.
The remaining subjects were randomized into a qi therapy group (n
18) and a placebo control group (n
18)
by block randomization. The subjects were informed that
they would receive one of two types of qi therapy, each of
which had the potential to relieve premenstrual symptoms
because we introduce the nature of qi therapy and procedures of experiment. They did not know which treatment
they received. Subjects were blinded as to whether they were
receiving real or sham qi therapy, as were the clinical observers assessing the endpoints. Four assistants contacted the
subjects and checked their diaries.
The groups received 10 minutes daily of qi therapy, or
sham qi therapy, 14, 7, 4, and 1 day before the menses of
the first and second cycles (total eight times over two cycles) in addition to completing the PMS diaries. To time the
exact date of the cycle, we used the Billings Ovulation
Method (BOM; Billings, 1982). The BOM is a method of
natural family planning based on a single-index cervical mucus parameter that enables a woman to recognize her time

of potential fertility. It also enables her to recognize the infertile parts of her cycle after ovulation and in the preovulatory phase of the cycle. All of the subjects learned about
this method by viewing videotapes about BOM several
times. Thus, there were three missed cases of menstruation
date in the second cycle (two in the experimental and one
in the control group) and two missed in the third cycle (one
in each group). For both of those cases, the subjects received
treatment immediately. The study received institutional approval from the Human Investigation Ethics Committee and
administrative approval from the Human Subjects Review
Board in Workwang University Hospital and School of Medicine before we approached the subjects and obtained written consent from all of them. After the experimental periods, both groups were offered complimentary qi therapy on
a volunteer schedule. All subjects completed the study and
received a free membership card to receive complimentary
qi therapy for 2 months (valued at approximately US $300).

Premenstrual symptoms diary

The PMS diary allowed the subjects to list 27 common
symptoms of premenstrual distress: 19 symptoms proposed
by Abraham (1982) and 8 from the CU-PS calendar used at
the PMS clinic in the Catholic University Medical Center,
Seoul, Korea. Each symptom was scored from 1 to 4 (1,
none, symptom not present; 2, mild, noticeable but not troublesome; 3, moderate, interferes with normal activities; 4,
intolerable, unable to perform normal activities), according
to the intensity experienced by the patient. The symptom
items were grouped into five factors: negative feelings, pain,
autonomic nervous system reactions, water retention, and
behavioral changes. We used subscales according to the results of the previous study using a Q-methodological approach (Jang, 1999). Analysis of this experiment indicated
a high level of internal consistency for the total PMS scale
(Cronbach 
0.94, which is based on all 27 symptoms).

Interventions
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 female nurse, 36
years old, who had practiced qi training for 8 years. Qi therapy was administered by the standard procedures outlined
in the textbook for qi therapy and there were no differences
between interventions.
The subjects received attention for 10 minutes according
to described procedures in the following standard sequence.
1. The qi master centers the self, forming a conscious intent to help the subject while becoming mentally aware
of the self as one with the cosmos.
2. The qi masters hand is moved approximately 310 cm
from the body in a pattern from head to toe, with the master becoming aware of changes in sensory cues.

459

EXTERNAL QI THERAPY REDUCES PMS

3. The qi master concentrates on areas of perceived accumulated tension in the subjects body and subjectively
projects qi from his or her hand.
4. The master then concentrates attention on specific perceived directions of energy flow (sensory cues), finishing by holding the subjects feet.
5. The subject is turned over and receives the same procedure for 5 minutes on the other side of the body.
Sham QT was administered by the same qi master, who
aimed to mimic the gestures used in the actual qi therapy
without any effort or intention to emit real qi. She followed
the experiment schedules and attempted to emit qi with positive thinking to restore harmony and balance to the energy
systems of the subjects or mimicked it using the same protocol so that the subjects were unaware of her intentions.
She was not involved in any other aspect of the study. The
master who delivered the two treatments appeared and behaved equally credibly to an independent observer. The real
qi treatment and placebo treatment were administered in no
set order during the treatment routine.
Only one qi therapy practitioner was used in this study
to maintain consistency of the intervention protocols and
minimize practitioner bias.

Statistical analysis
All analyses were performed using the SAS statistical
package for personal computers, version 6.12 (SAS Institute, Cary, NC). The results present as means  standard
TABLE 1. CHARACTERISTICS
Characteristics
Age (yr)
Age at menarche (yr)
Menstruation
Cycle
Duration
Pattern
Regular
Irregular
Amount
Profuse
Moderate
Scanty
Perceived health condition
Good
Normal (average)
Poor
Relief way of PMS
Rest
Oral analgesics
Heat pack
Psychologic diversion
Total premense score

OF

SUBJECTS

deviations (SD). Total premenstrual means for each of the

symptom categories were calculated from the scores for the
week before menstruation, at the first (baseline), second, and
third cycles. 2 and t tests were used to compare the homogeneity of general characteristics and categorical variables
between placebo and experimental groups. Two-by-three repeated-measures analysis of variance (ANOVA) was used
to examine the differences in scores of menstruation symptoms and subscales between two groups (placebo-controlled
and qi therapy) as three repeated factors (months [first {baseline}, second, and third cycle] of each premenstrual symptom [17 days before menstruation]).

RESULTS
The demographic characteristics for the subjects are
shown in Table 1. The groups did not differ significantly in
age, age at menarche, the duration, pattern, and amount of
blood loss in the menstruation cycle, perceived health state,
method of relieving PMS, or total PMS score.
Figure 1 shows the means and SDs for total PMS scores
for the qi therapy and placebo control groups for the three
periods. For each of these three measures, total premenstrual
scores were similar for the two groups during baseline charting, and showed greater reduction for the qi therapy group
than the control group after 1 and 2 months of treatment.
Repeated-measures ANOVA on total PMS score revealed a
significant effect of time [F(2,68)
26.41, p  0.001] and
ON

QI THERAPY

AND

PLACEBO CONTROL

Qi therapy (n
18)

Control (n
18)

20.78  1.83
13.55  0.78

22.16  2.81
13.78  0.88

1.76
0.80

0.09
0.43

30.83  4.52
5.44  1.10

29.89  4.84
5.50  1.38

0.60
0.13
1.03

0.56
0.90
0.32

0.18

0.91

2.49

0.29

0.38

0.28

0.50

0.62

8 (44.5%)
10 (55.5%)

11 (61.1%)
7 (38.9%)

3 (16.7%)
13 (72.2%)
2 (11.1%)

4 (22.2%)
12 (66.7%)
2 (11.1%)

14 (77.8%)
4 (22.2%)
0 (0.0%)

10 (55.5%)
7 (38.9%)
1 (5.6%)

5
5
5
3
68.87

(27.8%)
(27.8%)
(27.8%)
(16.6%)
 13.40

Values are express as mean and standard deviations.

PMS, premenstrual syndrome.

9
5
1
3
66.88

(50.0%)
(27.8%)
(5.6%)
(16.6%)
 10.29

t or 

460

JANG ET AL.
cant group-by-time interaction effect [F(2,68)
7.12, p 
0.01] and a significant time effect [F(2,68)
9.30, p 
0.001]. For pain and water retention, the pattern was similar between groups. The repeat-measures analysis for the
pain scale was statistically significant for group-by-time interaction [F(2, 68)
10.65, p  0.001, HF  
0.87] and
time effect [F(2, 68)
23.6, p  0.001, HF  
0.87].
Likewise, the repeat-measures analysis for the water retention scale showed a significant group-by-time interaction
[F(2, 68)
8.24, p  0.001], time effect [F(2, 68)
23.50,
p  0.001], and group effect [F(1, 34)
6.64, p  0.05].
There were significant time effects in autonomic nervous
system reactions [F(2, 68)
4.47, p  0.05, HF  

0.92] and behavioral changes [F(2, 68)
14.55, p  0.001].

FIG. 1. Qi therapy reduced total premenstrual syndrome (PMS)

scores compared to placebo-treated controls. PMS symptoms were
reported at baseline and during the second and third menstrual cycles. Values are means and standard deviations. There was significant group-by-time interaction (p  0.001).

a significant group-by-time interaction [F(2,68)
9.89, p 

0.001].
The self-reported symptoms of PMS (negative feelings,
pain, autonomic nervous reaction, water retention, and behavioral changes) are shown in Table 2. For the negative
feeling scale there was a significant decrease in the qi therapy group but not in the placebo group. There was signifi-

TABLE 2. EFFECTS

OF

QI THERAPY

ON

DISCUSSION
Women in this study who received qi therapy reported
fewer premenstrual symptoms. There were significant differences in the improvement of symptoms of negative feeling, pain, water retention, and total PMS symptoms between
subjects in the qi therapy and the placebo control groups.
Statistically, the improvements in the qi therapy group were
significantly greater than those in the placebo control group.
This difference might be interpreted as being caused by the
effects of qi on the body of women experiencing a low level
of qi. Thus, qi therapy could have an important role for managing the various symptoms of PMS.

SYMPTOMS

OF

PREMENSTRUAL SYNDROME

Time
Subscale
Negative feeling
Qi therapy
Placebo

Baseline

2nd Cycle

3rd Cycle

15.29  2.61
14.22  2.68

12.41  1.24
14.22  2.45

12.05  1.23
13.87  1.81

Group  time
F (2,68)
7.12*
10.65*

Pain
Qi therapy
Placebo

14.52  4.22
14.05  3.49

11.71  2.72
13.65  2.64

10.03  2.40
13.14  1.82

Autonomic nervous reaction

Qi therapy
Placebo

12.52  2.11
12.22  1.54

12.11  2.16
12.33  1.88

11.44  188
11.67  1.47

Water retention
Qi therapy
Placebo

13.67  3.50
13.44  2.39

10.28  1.36
12.50  2.00

09.40  1.73
12.38  2.84

Behavioral change
Qi therapy
Placebo

12.88  3.37
12.94  2.44

11.86  2.34
12.28  1.75

10.15  1.74
11.84  1.82

Values are express as mean and standard deviations.

*p  0.001.

0.52

6.64*

2.88

461

EXTERNAL QI THERAPY REDUCES PMS

The present study showed a significant reduction of pain
levels in the qi therapy group compared with placebo-treated
controls. This finding is consistent with prior work. According to our recent report, qigong therapy increases oxygen and decreases carbon dioxide concentrations in the
blood (Lee et al., 2002). This may enable the removal of
pain-inducing substances such as metabolic waste products
from the tissues. Qi therapy may also enhance the circulation of pain-killing substances such as endorphins and other
agents to control pain (Sancier and Hole, 2001).
There were significant improvements in the PMS symptoms of water retention and in negative feelings. The improved supply of qi may thus have harmonized qi and blood,
and restored the health of those meridians related to the
uterus. There is evidence that women have increased norepinephrine receptor sensitivity during the few days before
menses (Ghose and Turner, 1977). This hypersensitivity
might explain the commonly experienced increases in negative premenstrual feelings such as anxiety, depression, and
anger because these moods are heavily influenced by the
noradrenergic system. In our recent reports in a randomized
placebo control study, qi therapy reduced the blood pressure, stabilized the sympathetic nervous system, and decreased cortisol levels compared to placebo controls (Lee et
al., 2001b, 2003b). Regular qi therapy is believed to result
in a decreased norepinephrine response that may help alleviate these premenstrual symptoms, but further study is
needed to clarify this.
Some nonpharmacologic methods especially related with
relaxation therapy, cognitive therapy, and manual therapy
have suggested that there is high treatment response for PMS
patients (Blake et al., 1998; Goodale et al., 1990; Hernandez-Reif et al., 2000; Oleson and Flocco, 1993). The results
showed that a 22% reduction in PMS symptoms by massage
therapy is similar to that produced by qi therapy (Hernandez-Reif et al., 2000). The 22% reduction in premenstrual
symptoms found by using true qi therapy directed at subjects is lower than the 44% improvement found by Blake et
al. (1999) in women who received cognitive therapy. Moreover, relaxation response management and reflexology for
PMS has achieved successes of 58% and 46%, respectively
(Goodale et al., 1990; Oleson and Flocco, 1993). However,
these are difficult to compare. First, the present study did
not use the full potential of the patients active participation
in the healing process or self-practice of qigong. Second, the
previous studies used different assessment measures for
evaluating PMS, and both invasive and noninvasive therapies for relieving the symptoms. A clinically controlled comparison of several different noninvasive therapies for women
using the same PMS assessment form would be valuable.
Although we found that qi therapy gradually improved
the symptoms of PMS compared to the placebo control
group, additional evaluation of residual effects of qi therapy
is needed for clinical applications. More objective clinical
measures are needed in addition to the self-reported im-

provement found using a PMS diary. Further studies should

also examine the possible effects of qi therapy on the hormonal changes associated with the menstrual cycle to clarify the possible mechanisms involved.

ACKNOWLEDGMENT
This study was supported by grants from Wonkwang
Health Science College (2004).

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Address reprint requests to:

Myeong Soo Lee, Ph.D.
Center for Integrative Medicine
Institute of Medical Science
Wonkwang University
Shinyong-dong 344-2
Iksan 570-749
Republic of Korea
E-mail: [email protected]
or [email protected]