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Indications from DÄGfA

The German Medical Association for Acupuncture e.V. (DÄGfA) with around 8,300 members is a self-regulated professional institution for medical doctors that seek education in acupuncture and Chinese medicine. Founded in 1951 it is with the AGTCM one of the oldest German acupuncture societies.

They offer medical doctors a training path to practice acupuncture that is covered by the national German health insurances. A medical doctor in Germany must go through a 200 UE (UE= Study Credits roughly the equivalent of one hour of teaching in a classroom setting). The attendance of courses must be spread over 24 months and doctors will need to pass an exam at the Ärztekammer and its local medical examination board for qualifying doctors beyond their GP (General Practitioner)-status to be able to advertise their acupuncture offering to the public.

The DÄGFA lists the following indications for acupuncture on their website:

  • Shoulder and arm pain
  • Back pain
  • Headache migraine
  • Shoulder and arm pain
  • Elbow pain
  • Myofascial pain
  • Sleep disorders
  • Hay fever

What it takes for a doctor to practice acupuncture

More information on the training curriculum for medical doctors to practice acupuncture in their clinics where the treatment is covered by the national health insurances:

Acupuncture training

A doctor needs 120 units of further training with practical exercises (Teaching is divided into curriculum units G1 to G15, according to Sections A-E of the course book of the German Medical Association) and then another 60 units practical acupuncture treatment as well as 20 units being taught in a case-based seminar setting.

For the 60 units practical acupuncture treatment and 20 units of case-based teaching, the doctors may attend so-called case seminars as part of the practical courses (GP). The block A Basics (G1-G3) must be completed before G4 to G15 can be taken

Between the first course (G1) and the last practical course (GP) must be at least 2 years. After completing the 200 hours, doctors may then apply for the exam at their local medical examination board. There is a 1-day preparatory / refresher course available for this exam.

The exam consists of a written part (10 open-ended questions) and practical supervised discussion / examination in a small group setting.

Other additional training needed

  • 80 units in psychosomatic basic care
  • 80 units in special pain therapy

Indications from the SMS

The SMS – Societas Medicinae Sinensis (International Society for Chinese Medicine) is self-regulated professional body headquartered in Munich. Its purpose is the promotion of Chinese Medicine. The SMS was founded in 1978 by Prof. Manfred Porkert – who held a a PHD in Sinology & Philosophy. He was joined by Prof. Dr. med. Carl-Hermann Hempen – who is a medical doctor and professor of TCM at Munich University. He still runs his own clinic in Munich.

The SMS has divided the field of Chinese Medicine into two groups:
a) Acupuncture, Herbal Medicine – for this it only allows medical doctors or medical students to attend its course offerings.
b) Tuina, Dietetics and Qigong – which is open to all other healthcare professionals (like Heilpraktiker, midwives, physiotherapists etc.)

The SMS lists the following indications for Chinese Medicine:

Internal diseases:
Allergies, hay fever, bronchial asthma
Acute viral infections
Chronic bronchitis
Irritable bowel, irritable stomach
Food allergies
Chronic diarrhea
Constipation
Crohn’s disease and ulcerative colitis (IBD)
Chronic hepatopathies
Functional heart disease
Vegetative cardiac arrhythmia
Latent hypertension
Rheumatic diseases
Anemia
TCM as a concomitant therapy for cancer

Neurological and psychiatric diseases:
Idiopathic facial palsy
Polyneuropathy
Stroke rehabilitation
Dizziness
Multiple sclerosis
Minimal cerebral dysfunction
Developmental disorders in childhood
ADHD
Sleep disorders
Depression and anxiety disorders
Psychovegetative states of exhaustion
Concomitant therapy for addictions

Pediatric diseases:
Increased infections
Chronic runny nose
Cough
Indigestion
Tendency to constipation
Functional abdominal pain
Allergies (neurodermatitis, asthma, hay fever, food)
Restlessness and trouble sleeping
Headache
ADHD
Enuresis

Chronic pain conditions:
Back pain, sciatica, lumbar spine syndrome, cervical spine syndrome
Joint pain (knee, hip, shoulder, elbow)
Tendinosis like tennis or golfer’s elbow
Neuralgia, trigeminal neuralgia, intercostal neuralgia, zoster neuralgia
Phantom pain, stump pain
Tension headaches and migraines
Fibromyalgia and rheumatic pain

Gynecology and childbirth preparation:
Dysmenorrhea
Menstrual cycle disorders
Amenorrhea
Chronic genito-vaginal inflammation
Fertility disorders
Pregnancy sickness
Oedema and pain in pregnancy
Birth relief
Birth preparation
Shortening the duration of the birth
Climacteric syndrome

Skin diseases:
Acne
Rosacea
Urticaria
Pruritus
Psoriasis vulgaris
Neurodermatitis
Chronic eczema
Herpes zoster
Herpes simplex
Lichen

Urological diseases:
Cystitis
Prostatitis
Functional disorders of the urogenital tract
Irritable bladder
Urinary incontinence
Nocturnal enuresis
impotence
Infertility

Eye diseases:
Conjunctivitis
Uveitis
Juvenile myopia
glaucoma
Sicca syndrome
Incipient macular degeneration

ENT diseases:
Allergic rhinitis (hay fever)
Acute and chronic viral infections
Sinusitis
Globe feeling
Loss of smell
Tinnitus
Recurrent otitis

Indications from BMAS

The British Medical Acupuncture Society BMAS was founded in 1980 as an association purely for medical doctors interested in acupuncture. Since 2002, membership has been open to most statutory regulated healthcare professionals. Acupuncture in the UK has not been predominantly the domain of statutory healthcare professionals, but acupuncture practitioners who obtained their training and experience from a variety of teaching providers (like small private schools and colleges providing teaching in Chinese Medicine and acupuncture).

The BMAS decided in 2017 to extended their membership scheme to healthcare professionals who are voluntary regulated, provided that their regulatory body is overseen by the PSA and that acupuncture falls within the scope of practice. This enabled TCM practitioners, physiotherapists, other healthcare professionals and midwives to join the BMAS.

There are now over 1,900 members who use acupuncture in primary or secondary care settings.

The BMAS, staff and members frequently publish their research in the AIM Journal (‘Acupuncture in Medicine’). Since around the year 2000 and in particular with Dr. Mike Cummings taking a leadership position in the BMAS, there has been a great effort to provide a working definition of the term ‘Western Medical Acupuncture

Western Medical Acupuncture is based on the theory and empirical treatment protocols customary taught under the TCM Acupuncture curriculum minus any references pertaining to Chinese Medicine Theory that features terms like Yin/Yang, 5 Phases and Zang Fu theory. It has also incorporated the knowledge domanin of Dry Needling and Electro Acupuncture.

Dr Mike Cummings frequently publishes updates on the latest scientific evidence for using acupuncture. He is also the co-author of one of the standard textbooks in Western Medical Acupuncture:

Filshie J, White A, Cummings M. Medical Acupuncture – A Western Scientific Approach. 2nd edition. London: Elsevier; 2016.

A summary of the conditions covered by the latest research report can be found below:

  • Chronic low back pain
  • Chronic headache
  • Knee osteoarthritis (OA Knee)
  • Hip osteoarthritis (OA Hip)
  • Shoulder pain
  • Nausea & vomiting
  • Overactive bladder
  • Chronic constipation
  • Stress urinary incontinence
  • Allergic rhinitis
  • Hot flushes

Indications from BAcC

The British Acupuncture Council (BAcC) is the leading self-regulatory body for the practice of traditional acupuncture in the UK. For becoming a member, practitioners must practice in the UK and have proof of an equivalent of 3 years of full-time education in acupuncture / Chinese Medicine.

The BAcC provides a recent overview of scientific evidence of those conditions that can be treated with acupuncture:

Pain
Chronic pain in general
Chronic pelvic pain
Chronic prostatitis
Osteoarthritis (Knee and hips))
Neck pain
Shoulder pain
Low back pain
Plantar heel pain (plantar fasciitis)
Lateral elbow pain (tennis elbow)
Temporomandibular pain

Headache and migraine
Tension-type headaches (as a preventive treatment)
Migraine (all types)

Allergic respiratory conditions
Allergic rhinitis (hay fever)
Allergic asthma

Digestive system
Constipation
Irritable bowel syndrome (IBS)
For diarrhoea-predominant IBS
For constipation-predominant version of IBS
Dyspepsia

Urinary incontinence

Infertility
Assisted conception (IVF and ICSI)
Acupuncture just before and after the embryo transfer

Natural fertility: female
Help with menstrual and ovulatory problems in women who are having trouble getting pregnant
Focus on polycystic ovarian syndrome
PCOS-related infertility,

Male infertility
Improvement of sperm characteristics.

Mental health
Depression
Depression with physical pain
Specific groups of people with depression, for example post-natal, with cancer and those convalescing after a stroke

Anxiety
Generalised or chronic anxiety; much more for
Situational anxiety, for example pre-operative, exam-related or associated with stressful work.

Situational anxiety trials have often used auriculotherapy for its convenience and effectiveness,

PTSD
Military & Emergency Services personnel

Insomnia
Insomnia (in general)
Insomnia with anxiety/depressive symptoms and fatigue.

The BAcC lists the following conditions and diseases that can be treated with acupuncture:

A
Acne
Allergic rhinitis
Anxiety
Arrhythmias and Heart Failure
Asthma

B
Back pain
Bell’s palsy

C
Cancer care
Carpal tunnel syndrome
Childbirth
Chronic fatigue syndrome
Chronic pain
Colds and flu
COPD
Coronary heart disease
Cystitis

D
Dementia
Dentistry
Depression
Dysmenorrhoea

E
Eczema and Psoriasis
Endometriosis

F
Facial pain
Female fertility
Female fertility & IVF
Fibromyalgia
Frozen shoulder

G
Gastrointestinal tract disorders
Gout

H
Headache
Herpes
HIV infection
Hypertension

I
Infertility ART
Insomnia
Irritable bowel syndrome (IBS)

K
Kidney stones

M
Male infertility
Menopausal symptoms
Migraines
Multiple sclerosis

N
Nausea and vomiting
Neck pain
Neuropathic pain

O
Obesity
Obstetrics
Osteoarthritis

P
Palliative care
Parkinson’s disease
PCOS
Post-operative pain
Post-traumatic stress disorder
Premenstrual syndrome
Puerperium

R
Raynaud’s
Research digest
Rheumatoid arthritis

S
Sciatica
Sinusitis
Sports Injuries
Stress
Stroke
Substance misuse

T
Tennis elbow
Thyroid disease
Tinnitus
Type-2 Diabetes

U
Urinary incontinence

V
Vertigo

Indications from AGTCM

The AGTCM is Germany’s largest self-organised institution representing professional Chinese Medicine practitioners both with a Heilpraktiker-work license, medical doctors and midwives.

It is also the organizer of Germany’s biggest annual conference on Chinese Medicine in Rothenburg/OT.

The following conditions are highlighted on the AGTCM website:

Hay fever & allergies Treatment protocols may include acupuncture and herbal prescriptions. Acupuncture treatmenst focus on:

  • relieving symptoms
  • improving the immune system reponse
  • addressing secondary weaknesses to ensure that the immune system is not compromised

Stress-related symptoms and stress-induced illnesses
Acupuncture works both on the physical and mental level, focusing on the patient’s very own list of reported symptoms, mood changes as well as motivational challenges.

Neurological conditions
One of the domains of TCM is neurology. In China, the accompanying treatment of strokes with methods of Traditional Chinese Medicine (TCM) is routine. There are emprically proven and widely applied needle protocoals for neurological conditions such as strokes, paralysis, etc.

Musculosceletal pain / joint pain
From the age of 45, almost every second person suffers from painful joints. The knee joints are most commonly affected. The diagnostic approach in Chinese Medicine pays particular attention to the nature of the perceived pain (dull, stabbing, “electric”, pain in motion, pain in rest etc.) to derive tailored acupuncture treatment protocols.

The AGTCM has also published a summary paper documenting clinical research on acupuncture applications (including research up to 2008).

Short summary: yin/yang, qi and 5 phases / Elements

An explanation of the basic terms of Chinese medicine

Yin and Yang

Yin stands for “substance and the juice of life”, our material basis.

This is shown in the ability to relax, restful sleep, good nerves, serenity, patience and calm. The effect is directed downwards. Further assignments are: the night, autumn and winter, cold, passivity and our blood. Yin is assigned to the storage organs. These are the lungs, kidneys, liver, heart, pericardium and spleen.

Yang stands for “energy and vitality”, dynamism and movement.

Yang is involved in all active processes in our organism. The effect is directed upwards. Further assignments are: the day, spring and summer, light, warmth, activity and our life energy Qi. Yang is assigned to the hollow organs. These are the Large Intestine, Bladder, Gall bladder, Small Intestine, Triple Heater (regulates temperature and energy movement) and Stomach.

We are healthy and our self-healing powers are active when Yin and Yang are in a balanced relationship to one another. Illness is always an imbalance between in Yin and Yang.

Qi – a definition

Qi is the energy, our life force, it flows through and invigorates all physical, emotional and spiritual processes in the body. It is assigned to the Yang. Blood (in Chinese: Xue) is the material basis for Qi and is assigned to the Yin.

In TCM a distinction is made between prenatal and postnatal Qi. The prenatal or innate qi is inherited from parents and ancestors. This is stored in the kidneys and is our essence.

The postnatal Qi is obtained from food and the air we breathe, which is why nutrition and exercise are so important. The Qi flows in the so-called meridians, but also circulates freely in the body – such as the Wei Qi, our defense energy. The Qi expands during the day and is active (Yang), at night it retreats inside to regenerate (Yin).

Qi can be abundant or deficient, stagnated, blocked or knotted. Abundance manifests itself in yang or heat symptoms such as inflammation, rather sharp pain, high fever and acute events, deficiency, on the other hand, are mostly yin or cold symptoms such as chills, numbness, edema, chronic and rather dull pain.

The five phases of change – The 5 Elements

The doctrine of the five phases of change or the five Elements describes the relationships and principles according to which dynamic processes (changes) take place. The five elements in TCM are: Wood, Fire, Earth, Metal and Water. Each of these phases of change is assigned different qualities / characteristics:

WOOD: the rising Yang, Liver and Gallbladder, anger (also suppressed anger) and creativity, spring, birth and growth, morning, the color green, the taste sour,

FIRE: Yang, Heart and Small Intestine, the joy, training and development, the summer, the blossom, the noon, the color red, the taste bitter

EARTH: Yin and Yang in balance, Spleen / Pancreas and Stomach, worry and brooding, maturity and transition, the late summer or the middle, the afternoon, the color yellow, the taste sweet

METAL: the small Yin, Lungs and Large Intestine, the sadness, the parting and structure, the autumn, the harvest, the retreat, the color white, the evening, the taste sharp,

WATER: Yin, kKdney and Bladder, fear and anxiety, inner contemplation, winter, the color black or dark blue, the night, the taste salty

All Elements are connected and interact with one another.

Treating the Center / the Middle in Chinese Medicin

The Middle or center in Traditional Chinese Medicine (TCM) and why treating the abdominal area is important

In TCM, the inner abdominal organs are assigned to the Earth element and the center. Nurturing and maintaining the central energy is a fundamental principle in Chinese Medicine. The main function of the center is to convert the essence of food into Blood, Qi and body fluids and to distribute it throughout the body. This is how the body is nourished. The center is also known as the “Engine for postnatal Qi”.

The Earth symbolizes the nourishing and resting pole of the body and stands for balance, pause and digestion, also on the emotional and spiritual level.

In many cultures the Earth is a symbol of motherliness, preservation of life, security, security, nutrition, abundance and generosity, compassion, recognition, love and connectedness, being at home, welcome, order and harmony.

All influences that come from outside – climatic, social, intellectual and of course the food – are absorbed, processed and digested in our midst, also emotionally and mentally.

The Earth provides the energy for almost all vital functions. That affects the whole person. If the energy is good, our metabolism works and we are well supplied with Blood and Qi.

The assigned functional organ groups are the Stomach (Yang) and the Spleen (Yin).

The Spleen (and also pancreas) functional group controls the transport and transformation of food and fluids. It controls the blood and muscles. The Spleen holds the blood in the vessels and organs in place and supplies them with warmth, blood and energy. It is the source of Qi and Blood and controls the rise of Qi. The energy opens in the lips and manifests in the mouth. She controls the saliva. The associated positive mental aspect is Yi, the thinking and the emotion, that easily turns into a pathology, is worry and the brooding.

The functional circuit of the stomach as a Yang organ controls the absorption and processing of food and is considered to be the origin of fluids. It is responsible for the further transport and the descent of Qi (together with the Lungs).

A common TCM syndrome is the so-called “Spleen Qi weakness or defiency”. It complicates and promotes many other syndromes. The deficiency of the Spleen manifests itself primarily in physical weakness, tiredness and powerlessness, dysfunctions of food transformation and transport, digestive disorders, tendency to obesity, organ subsidence (ptosis). Reasons for this are often a “wrong” diet (too irregular, low in nutrients and too cold), physical and mental overwork, chronic illnesses, too much worry and brooding. According to TCM, this can lead to increased moisture and phlegm, which greatly weakens the “middle” energy.

For the treatment and care of the middle, the area of life care, especially eating habits, is of particular importance.

There are other important energy centers in the middle of the body that can be included in the treatment.

  • the area of the solar plexus and diaphragm
  • the area around the navel.
  • the “mid” section of the so-called “lower dantien” between the pubic bone and the navel

There are acupuncture points in the vicinity of the genitals and between the pubic bone and anus – often referred to as the “lowest” part of the lower dantian. For specific ailments they can are in fact needled in the clinic. However, there is use is linked to very concrete painful conditions regarding uro-genital, fertility or conditions linked to the rectum (haemorrhoids, anal prolapse, anal fissure).  Most often the practitioner instructs the patients to self-massage or acupressure these points.

For these ailments many acupuncture points also lie on the back of the body on the sacrum.



Introduction to TCM

Traditional Chinese Medicine (TCM) assumes that the life energy Qi flows incessantly and changes constantly. Qi animates all living beings and creates life. All Qi manifestations have a share of Yin and Yang.

The energetic exchange between heaven and earth, between Yin and Yang, is also evident in the seasons and in the alternation of day and night. This directly affects the energy that flows within each of us. Qi expands and is active during the day, while at night it retreats inside to regenerate. “The only constant is change”.

Another concept of Chinese Medicine is the teaching of the five phases of change.  We humans are part of nature, our organs and physical, as well emotional and mental functions reflect the order of nature. Each element brings forth, nourishes and leads to the the next element (Creation Cycle – Sheng).  In addition, there also other pathways of how the elements influence each other:

  1. Controlling cycle (Ko)
  2. Insulting cycle (Wu)
  3. Overacting cycle (Cheng)

Traditional Chinese Medicine (TCM) looks back on a tradition of over 2000 years. The philosophy on which it is based is a complex, multi-layered concept.

Humans are embedded in nature between heaven and earth and form a universal unit with it. In Chinese Medicine, the human being is seen as an organic whole, a part can only be understood in relation to the whole. We looksat the dynamics of life, everything is in constant change. This change is unintentional. Every state, when it is reached, already contains its opposite. A reached maximum state is unstable and must collapse.

Yin and Yang are two forces in the universe that are effective everywhere. Their interplay is the basis for the continuous process of every natural change, every movement in the universe and the basis of man himself. Yin and Yang are relative quantities, they determine each other, are dependent on one another, together they form a whole, they are constantly in motion and in constant change.

In the Su wen (chap. 2) it says:

“Yin and Yang are the law of heaven and earth, the basis of everything, the parents of change, the origin of creation and destruction.”

We are healthy and our self-healing powers are active when Yin (vital fluids and substance) and Yang (vital force and energy) are in a balanced relationship to one another.

Yin signifies:

  • the ability to relax, restful sleep and good nerves, serenity, patience and calm. Sufficient substance and vitality are necessary for this.
  • the night, autumn and winter, passivity and standstill, the front, the lower and inner area of ​​the body, the inhalation, cold, wet and damp, direction downwards.
  • compressed matter, substances, that sink to the bottom.
  • darkness, cold, contraction

Yin is assigned to the storage organs, these are the lungs, heart, pericardium (also called master of the heart), spleen, liver and kidney.

Yang signifies:

  • dynamics, movement, resistance, joie de vivre, willpower
  • all active processes in our organism
  • sufficient energy (Qi), life force and warmth are necessary for this
  • the day, the spring and summer, activity and movement, the back, the upper and outer areas of the body, the exhalation, warm and dry, direction upwards.
  • dynamic energy
  • light, brightness, warmth, expansion

Yang organs transport fluids and blood, i.e. the large intestine, small intestine, triple heater (regulates temperature and energy movement), stomach, gall bladder and bladder.

Qi is the breath of life, like a stream, an invisible force that keeps all physical, emotional and spiritual processes going and lets us be alive. It pulsates, transforms, nourishes and is the engine of an ongoing cyclical change, filled with the energies of heaven (Yang) and earth (Yin).

Qi drives the blood, the nervous and lymphatic systems (Ying-Qi), it strengthens the immune system (Wei-Qi). It turns food into body substances, keeps organs in place, prevents excessive perspiration, keeps the body warm, and is the source of movement and growth.

Qi is everywhere in the body, its flow runs along certain channels, the so-called meridians. There are 12 main meridians corresponding to the main organs and 8 extraordinary meridians.



A primer in nutrition and Chinese Medicine

“When we eat with pleasure, the stomach directs the purest portion of the essence from the food directly to the heart and awakens our joy of life.”

Good eating habits are the most important principle for strengthening the energy of the center.

  • Prefer good quality and high quality food, seasonal and local food
  • Establish a daily rhythm with regular meals
  • Regular breakfast, lavish lunch and light dinner, the latter before 6:00 p.m.
  • Serve lots of warm / cooked food (preferably 2-3 times a day)

While eating:

  • Eat slowly and chew thoroughly
  • Don’t drink cold liquids with your meal, but rather clear and light soup, hot water or green tea.
  • Don’t eat right away after getting angry
  • Avoid exhausting discussions while eating
  • Do not eat completely full

Quality of food and food preparation:

  • Use organic ingredients (whenever your budget and availability permits)
  • No artificial food additives, no ready meals.
  • No microwave

Detailed advice:

  • Simple meals (do not combine too many different proteins and carbohydrates)
  • Lots of vegetables (preferably only briefly steamed or seared)
  • Boiled cereals (millet or barley, bulgur – together with some soy, coconut or almond milk, also suitable as a healthy breakfast)
  • Neutral foods to which you add warm and refreshing ingredients
  • Soups that warm the whole stomach (e.g. Chinese style)
  • Vegetables that grow in the ground

Food items with a (naturally) sweet flavour and neutral thermal properties have the following effect: strengthening Qi, harmonizing, moisturizing, relaxing, saturating, nourishing.

However the sweet flavour has no direction of action, i.e. it’s harder to digest. Therefore add other tastes. Too much sweetness creates moisture, which leads to phlegm. ‘Visible’ phlegm manifests as an excess in body fat.

However don’t be fooled by instagram and lifestyle magazine depictions of skinny and „sporty“ looking models. Healthy bodies have mainly the outline and body fat distribution visible in many Renaissence or classical art nude paintings.

About Qi

Qi is the invigorating energy of all processes, our life force or life energy. It animates all living beings, nature and the cosmos. It is an energy that is present in all forms of matter and is concentrated in living organisms.

In TCM a distinction is made between prenatal and postnatal Qi. The prenatal or innate qi is inherited from parents and ancestors. This is stored in the kidneys and is our essence.

The postnatal qi is obtained from food and the air we breathe, which is why nutrition and exercise are so important. The Qi flows in the so-called meridians, but also circulates freely in the body – such as the Wei Qi, our defense energy. The Qi expands and is active during the day (Yang), at night it retreats inside to regenerate (Yin).

Qi can be abundant or deficient, stagnated or blocked. Abundance manifests itself in Yang or heat symptoms such as inflammation, rather sharp pain, high fever and acute events, deficiency, on the other hand, are mostly Yin or cold symptoms such as chills, numbness, edema, chronic and rather dull pain.

Qi is the breath of life, like a stream, an invisible force that keeps all physical, emotional and spiritual processes going and lets us be alive. It pulsates, transforms, nourishes and is the engine of an ongoing cyclical change, filled with the energies of heaven (Yang) and earth (Yin).

It directs the blood, the nervous and lymphatic systems (Ying-Qi), it strengthens the immune system (Wei-Qi). It turns food into body substances, keeps organs in place, prevents excessive perspiration, keeps the body warm, and is the source of movement and growth.

Qi is everywhere in the body, its flow runs along certain channels, the so-called meridians. There are 12 main meridians corresponding to the main organs and 8 extraordinary meridians.

Qi is the invigorating energy of all processes, our life energy. It animates all living beings, nature, the cosmos. The Qi flows in the so-called meridians, but also circulates freely in the body – such as the Wei Qi, our defense energy.

Qi expands during the day and is active (Yang), at night it retreats inside to regenerate (Yin).