Combining Western medical techniques with Traditional Chinese Medicine presents many challenges for practitioners. Working in combination mental health and pain management practice further complicates treatment choices. Many patients seeking help for psychological problems also have corresponding chronic physical ailments. The opposite is also true. Most patients that have chronic physical ailments also have chronic corresponding psychological problems. A practitioner who is dealing with this type of patient is wise to consider the entire individual and both aspects of these expressions of illness.

In our practice we combine counseling, psychiatric, chiropractic, massage therapy and qigong to offered range of treatment that addresses the varied complaints of our patients. I have found, over almost 20 years of practice, that patients improve far more rapidly if they are offered both physical and psychological therapy when addressing their illness. Obviously an individual with a severe chronic injury, who is unable to work or perform normal household tasks, is going to be depressed. Who wouldn't be? What I find interesting is how often the illness or injury is a reflection of the individual's personality, and one of the keys to healing the injury is addressing the aspect of the personality that is "blocking" healing. For example, a woman receives a neck injury at work, damages vertebrae and is unable to work because of the pain. She stays home, the pain increases, and she is unable to return to work. She is surprised to be informed that doing dishes, mopping floors and carrying children is "work" and worsens her injury. She is frightened of not being a good wife, mother and person and so eventually becomes totally disabled as a result of her fear. This type of behavior is no surprise to the practitioner who routinely works with people, but how can qigong help heal injury and reduce the fear in an individual like this who has absolutely no interest in traditional oriental medicine or practice?

It is surprising how easily many of the principles of qigong can be woven into psycho- and physical therapy. Both Daoist (Taoist) and Buddhist qigong orientations can help make the connections between the natural order of life and healthy living in the world. Teaching qigong in a mental health setting for years had shown me how an anxious individual will move with the "energy" of anxiety. Angry individuals move with the "energy" of anger. Frightened individual move with the "energy of fear, and so on. Using qigong therapy or teaching qigong practice can alleviate some of the symptoms of an ailment, but if the individuals thoughts and behaviors remain distorted by fear, anger etc. the symptoms, and ailment are likely to return. I have seen qigong practice heal a troubled mind but just as often a see a troubled mind prevent an individual from receiving the maximum benefit of qigong practice.

My qigong masters have always stressed, "Qi follows the mind, the mind leads the Qi". Stagnant qi in the body can take many forms. It is necessary to discharge or drain stagnant qi in order to replace it with healthy qi. Just as lesions or infection or other "physical" manifestations of illness can block the healthy flow of energy, fear, anger and other potentially negative emotions can also block the healthy flow of energy. My qigong master Tianyou Hao in Cleveland stresses the importance of an open mind as well as an open body and places emphasis on "mind power" qigong as an integral component of physical practice.

Teaching qigong and taiji to mental health patients provides excellent examples of this healing process. A fifty-year-old male patient is receiving treatment for outbursts of anger and irritability that interfere with his close relationships. He also suffers from beginning arthritis in his hands and knees. He has received training in karate and is physically fit. During initial individual training in taiji, he has difficulty practicing "push hands". He remarks, "I feel I need to fight harder. If I do this (the soft movements of taiji) I will lose, and appear foolish". This man responds to challenge with fear and then anger, which encourage him to abrupt violent movement; this disrupts the natural flow of qi.

He also has difficulty receiving tuina and qigong treatments because they are not "hard" enough. Initially his movements are hard and rigid, his myofacia is in spasm and lacks suppleness. His personality is harsh and judgmental, and he is quick to argue and verbally attack. Combining traditional counseling techniques and principles with qigong and taiji practice illustrates to this patient the psychological and physical alternatives to his rigid combative orientation. His personality naturally gravitated to the more explosive discipline of karate but with training he began to develop an affinity to the graceful, gently powerful disciplines of taiji and qigong.

Simultaneous with this change to his physical orientation he experienced a "softening" of his personality. Strength is essential to this man, so to achieve this softening in his personality he had to know that there would be no weakness involved in any suggested change. As he integrated the principles of balance and energy flow into his physiology he was able to integrate these principles into his personality and actually improve his effectiveness in dealing with other people. In his qigong practice he was able to flow energy through his joints experiencing a reduction in rigidity and a corresponding decrease in arthritic pain. It is very important to me as a therapist that the fundamental personality of the patient is respected and preserved. By including the practice of taiji and qigong, this patient was able to change the behaviors that were interfering with his relationships, improve his arthritis while maintaining the values that were most important to him.

At the opposite end of the scale is the thirty four year old female patient who suffered from depression, anxiety attacks and fibromyalgia. She is a successful professional person and enjoyed an affluent lifestyle. Despite this she had frequent anxiety attacks and bouts of depression and feelings of helplessness that interfered with her daily work and personal routines. Typical of an individual with anxiety disorders her breathing was shallow and centered in her upper chest. Including taiji and qigong practice along with counseling, this patient experienced a typical response. In individual training utilizing "horse stance", Xia Dantien breathing and gentle push hand movement this patient burst into tears and exclaimed, "I'm frightened, I don't want to fight, I'm going to get hurt". This patient's posture was also rigid; the myofacia was tight and hyper tense with chronic myofacia pain. Different from the previous example, the male patient who was braced to fight, this patient was chronically braced to flee. This chronic state of tension and bracing contributed to, if not, caused the states of anxiety and fibromyalgia and contributed to the psychological depression. Using the philosophies of Daoist and Buddhist qigong and taiji as well as some of the movements of aikido and its philosophy of peaceful reconciliation through strength and balance helped this patient move from fear to confidence. This patient was also able to maintain her fundamental orientation towards pacification and peacefulness while acquiring a physiological and psychological sense of mastery and safety.

Combining of physical and psychological therapy is essential to the treatment of these types of chronic ailment. Both patients had lifelong histories of concomitant psychological and physiological trauma and illness. Both received prior unsuccessful treatment for their physical and psychological ailments. Both also reported satori (enlightening) experiences subsequent to a series of visits that combined talk therapy reinforced by physical qigong or taiji exercises followed by tuina massage or chiropractic. Common experiences are reported as feeling as if the "anger just left me" during qigong practice or "I suddenly felt in control" during push hands taiji. When the physical movements and mental concentration of qi practice are combined with the mentally cleansing thoughts of holistic psychotherapy the entire energetic matrix of the patient can begin to be restored.

The notion of using mind/body modalities is not particularly ground breaking. The practice of mind/body medicine has been around for years and has been an integral part of the programs at prominent facilities like Duke University's Center For Mind/Body Wellness. The emphasis of this article is the particular usefulness of qigong and taiji in treating these ailments because of the duality of their process. This duality allows for the existence of healing energy and assertive (martial) energy to coexist or to be indistinguishable. Other excellent bodywork disciplines like Feldenkrais, Rolfing and Alexander method work on the level of mind/body but can lack the flexibility to reframe fear or anger into confidence or peaceful reconciliation. This is vitally important because the impulses to fight or flee are among the strongest humans possess and when they become exaggerated by illness, injury or trauma such impulses can interfere with healthy living and healing. This requires that the astute healer be able to treat these impulses as an integral part of therapy. This is where qigong and taiji can become indispensable resources for practitioners working with chronic physical or mental illness.

Qigong and taiji instructors become familiar with many types of incorrect posture and movement in the course of teaching qi practice. The instructor's role is to help the student to practice correctly and thereby receive the benefits of qi. One aspect I emphasize in practice is how a student's thoughts influence their movements. A student who has a habit of tasking themselves with thoughts of "I have to get this" and use words like "make" and "force" often have abrupt choppy movements with a lot of tension and little grace. In the practice of push hands their style is more aptly called shove or strike hands. An astute instructor, when this is noticed, can ask a student: "What is that movement, what are you thinking right now". At this point the student often gives a revealing answer like "I feel like I have to win", or " I am afraid I will get hurt". If this is regarded as a verbal expression of blocked or stagnant qi the instructor can help clear or move the qi through verbal suggestion. The instructor can respond to a "I have to win" remark with "Take a long slow deep inhalation into your Xia Dantien, exhale out slow and thin through your Laogong and Yongquan, release the need to strive and fight and let them flow out of your body through your hands and feet and feel striving replaced with calm strong qi". Follow this with a brief explanation that combat is a state of mind. If the student releases combat, all that is left is movement. Calm balanced movement can respond to opposing movement in a far more effective and safe way than rigid combative movement. The combination of verbal and physiological instruction often speeds understanding and releases qi blocks in a way that either technique alone cannot accomplish.

It is also common to work with students who have difficulty maintaining erect posture, are easily frustrated and have a tendency to give up when challenged. Practice with these students can include horse stance Xia Dantien breathing and drawing in qi on the inhale from the earth through the Yongquan and from the universe through the Bai Hui filling the Dantien. The instructor can notice the student's difficulty concentrating or frustration with the practice and ask, "What is happening right now? What is making this difficult for you?" Common responses would include, "I just can't get this right" or "I'm just no good at this". The instructor can address the psychological qi block with a comment like "breathe the calm powerful qi from the earth and universe in to your dantien, release, on the exhale, your fear anxiety and insecurity, replacing them with calm powerful qi". Adding these components to some students' routine can help them, much more quickly, overcome deficiencies in their practice.

All of these examples are compilations of students and patients, simplified to illustrate the points. One does not need to be a trained psychologist or counselor to apply them to qi practice. While these may appear a departure from more traditional approaches to qigong and taiji practice, I believe they are based on sound traditional Chinese principles with the ideas presented in simplified English language. Viewing the examples as excessive yin balanced with yang or vise versa places them in a clearly traditional context. Thinking of anger or combativeness as a deficiency of shen or fear and anxiety as needing more jing makes these psychologically based principles more accessible to practitioners of Traditional Chinese Medicine (TCM). Again, this oversimplifies complex TCM principles, but it does make the concepts available both practitioners and instructors who would find them useful in practice.

The skillful practice of TCM, qigong and taiji requires an enormous amount of technical preparation and practice. Once this level of proficiency is achieved intuition plays a large part in training, diagnosis and treatment. At this level, the skilled instructor or practitioner can begin to "see" psychological or emotional expressions as qi flow or block. In TCM practice we can focus qi on internal organs and teach the patient to do the same. If we can recognize that there is a corresponding psychological or emotional block, we can assist the patient in labeling this and discharging what is unhealthy or adding what is necessary. Working with what Western medicine calls angina pectoris a practitioner may find a deficiency in heart yang. While addressing this in the traditional fashion the practitioner can also treat the emotional upset also associated with this condition and verbally encourage the patient to release, for example, the fear that is creating the anxiety and decreasing yang. It is possible to confuse the fear based aggressive energy that can appear as yang with the calm based assertive qi, which is true yang. A suggestion like "On the next exhale you can breathe out concerns about work or financial insecurity, and with the next inhale breathe in calming strengthening qi, replacing fear and anxiety and allowing them to drain out through your hands and feet". The skilled practitioner can learn to associate feelings associated with disharmony in the Zangfu system and can guide the patient in recognizing and treating these psychological/emotional ailments by also balancing emotional qi.

Combining Eastern and Western medicine also must combine the languages and concepts that express them. The Chinese concepts of the various forms of qi that influence the body and mind can provide a quantum leap in a Westerner's ability to understand the healing process. It also seems true that applying this concept to the energetic influence of emotions and treating them as integral to the qi process can improve our understanding of qi.

Those of us who believe in and practice complementary medicine are familiar with the constant task of educating practitioners of Western medicine to the benefits of TCM. In his recent article in Qi Journal Master Tianyou Hao encouraged us to "enjoy (a) more open, confident and effective" relationship between Western and Eastern medicine. Along with our task of educating Western medicine to TCM, we need to remain open to the inclusion of Western concepts in the practice of TCM.

Joseph E. Scanlon LPC/S, LMT, Fellow, American Academy of Pain Management. A Qigong instructor and TCM practitioner, Joseph Scanlon is owner and director of Counseling Center of Georgetown, a counseling, wellness and pain management clinic in South Carolina. Website www.healingprocess.org