Curse you, NEJM! The New England Journal of Medicine muddyied the medical waters twice in 2010: first with faint praise for acupuncture,1 and then making taijiquan sound more special than it is and giving “alternative” medicine an inappropriate boost because of a study showing that taijiquan has some beneficial effects for fibromyalgia patients.2 As explained by Dr. David Gorski for ScienceBasedMedicine.org, “Fibromyalgia, like many chronic conditions, truly sucks,” but:
… why on earth [are these findings presented as being] the least bit ‘alternative’ or ‘complementary’? Stripped to its essence and particularly stripped of its woo elements about qi, all taijiquan is exercise and relaxation, and we already know that exercise can be useful for fibromyalgia!
Tai chi and fibromyalgia in the New England Journal of Medicine: An “alternative” frame succeeds, Gorski (ScienceBasedMedicine.org)
Indeed! I am an experienced taijiquan practitioner — I practiced routinely for about 20 years, and to this day it grates on my nerves to see the steady stream of self-conscious dabblers butchering it. As both a taijiquan practitioner and a former alternative medicine practitioner, I agree with Dr. Gorski: it’s bizarre and ridiculous for the NEJM to present this evidence as some kind of a victory for alternative medicine.
Taijiquan is not part of alternative medicine
Taijiquan is routinely “claimed” by alternative medicine. For instance, the The National Center for Complementary and Alternative Medicine — which is kind of like a world headquarters for alternative medicine — calls taijiquan “a mind-body practice in complementary and alternative medicine.” Nonsense — you might as well claim fly-fishing, golf, and chopping veggies as part of alternative medicine. They’re meditative, sure, but not “medicine.”
Taijiquan is not prescribed or taught by alternative medicine practitioners: they are certainly all in favour of it (often for the wrong reasons), but the idea that it is some kind of staple of alternative medicine prescribing is simply wrong. The closest taijiquan comes to actually being a part of alternative medicine is in the form of casual recommendations to try it, in the same way that your doctor might say, “Maybe it’s time for a heart-smart vacation?” And even that’s fairly rare.
For that matter, I’ve known mainstream physicians to suggest taijiquan. Why wouldn’t they? This is the point: it’s gentle exercise, not magic.
For instance, Wang et al. are back in 2016 with another NCCAM-funded trial … demonstrating that taijiquan works no better than standard physical therapy (exercise) for knee osteoarthritis.3 But neither of them work particularly well for that condition.
Ironically, I actually taught taijiquan to my own patients
I ran a beach taijiquan class for my first couple years as a Registered Massage Therapist in Vancouver — patients were students, and students were patients. People just loved it, and were quite disappointed when I stopped doing it. The whole thing was quite unusual, not even remotely typical of alternative medicine. If it were, maybe you could say that taijiquan is a part of alternative medicine. But it’s not, and it isn’t.
The huge majority of taijiquan students outside of China were introduced to it by the International Taoist Tai Chi Society, an impressively effective organization with vast membership in thousands of active clubs around the world. The style of taijiquan taught by the ITTCS is notably pragmatic and slanted toward the simple benefits of gentle movement exercise. A large proportion of their students are older adults referred there by physicians who see it as a straightforward source of gentle exercise. The ITTCS is well aware of this and generally presents taijiquan in just that way. Their website’s page about the health benefits of taijiquan keeps it real and does not even refer to chi as a spooky force in the body (see Do You Believe in Qi?). The text sticks to the basics: “improved circulation, balance and posture; increased strength and flexibility; and reduced stress.”
Sure, taijiquan certainly comes with a lot of superstitious baggage, and in China it is thoroughly intertwined with their folk medicine. But I can eat sushi without bushido, and I can take what I like from taijiquan and ignore the rest.
I roll my eyes at NEJM’s tacit endorsement of taijiquan as alternative medicine.
Spelling taijiquan is tricky!
T’ai chi is not tai ch’i — moving the apostrophe changes the meaning.
For a gold star, always use either taiji or, even better, taijiquan — that’s the modern Pinyin transliteration. But the older Wade-Giles version, t’ai chi or t’ai chi ch’uan, is still common, and the simplified tai chi is acceptable and common. Just don’t mix up your chi with your ch’i. Ji and chi are not the same thing as ch’i and qi — almost everyone makes this mistake (including me, for many years). Ji/chi is a philosophical concept, a really deep thought, hard to define and translate, but “pole” or “ultimate” will do. Qi/ch’i refers to breath or life energy, like the western concept of vis vitalis (vital force) or the Greek pneuma (breath, spirit, soul). So t’ai chi really is not tai ch’i.
About Paul Ingraham
I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter.
- Berman BM, Langevin HH, Witt CM, Dubner R. Acupuncture for Chronic Low Back Pain. N Engl J Med. 2010 Jul 29;(363):454–461. PubMed #20818865 ❐ PainSci #54942 ❐
A bizarre and already infamous paper: bizarre because the authors clearly acknowledge that acupuncture is no better than a placebo, and bizarre because they conclude that it should be recommended, and most bizarre of all because it is published in The New England Journal of Medicine. Truly, one of the lowest moments in the history of that famous journal!
The best criticisms of the NEJM’s editorial choices here can both be found on Science-Based Medicine, by Drs. Crislip (NEJM and Acupuncture: Even the best can publish nonsense) and Novella (Acupuncture Pseudoscience in the New England Journal of Medicine). Dr. Crislip’s post is really quite funny.
- Wang C, Schmid CH, Rones R, et al. A randomized trial of tai chi for fibromyalgia. N Engl J Med. 2010 Aug;363(8):743–54. PubMed #20818876 ❐
- Wang C, Schmid CH, Iversen MD, et al. Comparative Effectiveness of Tai Chi Versus Physical Therapy for Knee Osteoarthritis: A Randomized Trial. Ann Intern Med. 2016 May. PubMed #27183035 ❐
This is an NCCAM-funded trial of tai chi for knee osteoarthritis. The risk of bias is probably high (NCCAM exists to fund studies of “alternative” medicine), and it’s the only trial of its kind, so the results and interpretation must be taken with a large grain of salt. (Also, author Chenchen Wang also produced Wang 2010, a study that was embarrassingly touted in The New England Journal of Medicine as a victory for alternative medicine. So this is a case where we really need to consider the source.)
204 patients did either tai chi twice or “standard physical therapy” — mostly light exercise — twice per week for 12 weeks. Both groups improved modestly and equally.
The effectiveness of exercise therapy for arthritic knees is been well-established by many trials, but it’s just as clear that the benefits are minor: according to Fransen 2015, just 12 points on a 100-point scale in the short term (and just 6 points after a few months). This study describes similar benefits in both groups as “substantial”: about 150 points out of the huge total of 2300 possible points for a WOMAC score. Translating that to an easier scale, the improvement was about 7%. While I’d never refuse a 7% improvement in a painful condition, it’s a strange number to call “substantial.” I think it damns both exercise therapy and tai chi with faint praise: they “work,” but not especially well.