Dao Yin exercise is a series of exercises that are very suitable for the health preservation of middle-aged and elderly people. It is not only an aerobic exercise but also a treatment method for a variety of diseases. According to the categorization of experts in this field [1], the practice of Dao Yin exercise mainly falls into four forms: mental activities, breathing regulation, limb movements, and self-massage. As a traditional exercise therapy, Dao Yin exercise integrates the above four exercises into a whole.
The medical value and therapeutic effects of Dao Yin exercise on various diseases have been fully recognized by doctors for many generations. With constant enrichment, development, and improvement, the combination of Dao Yin and modern exercise therapies has been explored in clinical research and applied to the prevention and intervention of physical and mental illnesses. Existing research into the therapeutic effects of Dao Yin exercise on physical illnesses mainly focus on lumbar spondylosis, limb diseases, cervical diseases, heart disease, central nervous disorders, immune dysfunction, and so on [7]. As for its intervention as treatment of limb joints, lumbar vertebrae, cervical vertebrae, mental illness, and the physique, the research subjects tend to be middle-aged and elderly people, while the research results are quite fruitive. As a great amount of research has proved the effectiveness of Dao Yin exercise, its philosophy, forms, methods, and therapeutic effects have gradually gained people’s recognition.
6.1. Therapeutic Effects of Dao Yin Exercise on Lumbar Spondylosis
Lumbar spondylosis is mostly caused by acute or chronic injuries of the spinal column or its surrounding soft tissues, the degeneration of the lumbar intervertebral disc, lumbar hyperosteogeny, etc. [43]. Clinically, it is mainly manifested by low back pain, lumbar motor disturbance, and pain in waist and lower extremities. Excessive sitting causes the imbalanced strength of the lumbar joints and muscles; that is, the tense muscles are always tense, while the relaxed muscles are always relaxed, resulting in poor blood circulation and decreased metabolic function. Dao Yin exercise generally involves wide stretches to exercise and relax muscles. As proved by a wealth of research results, practicing Dao Yin exercise does have therapeutic effects on the rehabilitation of lumbar spondylosis and the enhancement of lumbar and abdominal strength.
According to Qu and Zheng [2], practicing Dao Yin exercise, through its strengthening of muscles of the back, enhances muscle strength and endurance, provides stable support for the lumbar vertebrae, stimulates the nerves, and thereby maintains the stability of the spinal column and prevents low back pain.
Bai et al. [44] believed that the Wu Qin Xi, or five-animal exercise, can effectively stretch the spinal column in all directions. This is done so that the multifidus muscle can be effectively exercised, thereby strengthening the function of the multifidus muscle, increasing the stability of the spinal column and alleviating low back pain.
The research conducted by Ding and Wang [45] shows that practicing Ba Duan Jin, or eight silken movements, enhances the strength of the back and abdominal muscles, thereby significantly improving lumbar lordosis and sacral inclination. In other words, practicing Ba Duan Jin effectively controls the movement of the spinal column and pelvis and maintains their stability, thereby relieving low back pain and promoting lumbar activity.
Li et al. [46] randomly divided the middle-aged and elderly patients with chronic low back pain into two groups. The experimental group was treated by letting them practice standing-position Ba Duan Jin for 12 weeks, while the control group was treated with painkillers. Visual analogue scale (VAS), Oswestry dysfunction index, lumbar lordosis, sacral inclination, and lumbar activity of the patients in the two groups before and after the treatment were compared. The results showed that, before the treatment, there was no difference between the two groups in all the indicators, and that after the treatment, all the indicators of the two groups were improved, with more significant improvement found in the experimental group (P < 0.05 or P < 0.01). Therefore, it is concluded that standing-position Ba Duan Jin exercise can improve lumbar lordosis and sacral inclination, thereby significantly relieving chronic low back pain and improving lumbar activity.
Chen et al. [47] sifted out 60 patients with chronic low back pain from cases that met the selection criteria. These patients were asked to practice lumbar Dao Yin exercise, and the clinical effects were assessed by VAS and the JOA (Japanese Orthopaedic Association) scales for spinal cord function. After assessing the spinal cord function of the patients, it was found that practicing lumbar Dao Yin exercise had let the back muscles fully relax and stretch, which helped eliminate the fatigue of the back muscles and trained the muscles with load. This effect contributed to the enhancement of muscle strength and endurance as well as the improvement of lumbar function.
6.2. Therapeutic Effects of Dao Yin Exercise on Peripheral Musculoskeletal Diseases
People with musculoskeletal diseases often do not want to move the area where pain is located. The lack of limb motions leads to decreased activity and flexibility of the joints and even the possibility of inflammation [48]. Dao Yin exercise is practiced slowly at a constant speed, mainly involving the movements of the limbs and requiring a certain amount of exercise. Due to its benefits in physical coordination improvement [49] and the balance between the limb muscles and muscle groups [49], Dao Yin exercise can be well applied to the treatment of peripheral musculoskeletal diseases with therapeutic effects.
In the article “Characteristics of Traditional Dao Yin Limb Exercise from the Angle of Joint Motions” by You and Wang [50], the movement characteristics of Dao Yin exercise is concluded as the stretching training of the limbs and the isometric contraction of the opposing muscle groups.
According to Ru [5], a Dao Yin exerciser stretches the body under the guidance of his or her active consciousness. Such activity stretching the body not only balances the muscle contraction force around the joints of the limbs but also increases the volume of the limb tissue fluid, thus forming a stretch-fluid loop. Such exercise, if practiced for a long term, also brings about benefits to the central nervous system’s ability to regulate and control the muscles, thereby enhancing limb flexibility and physical agility.
Chen et al. [51] recruited 80 patients with knee arthritis from those who met the selection criteria (aged 40–75) and randomized them into the control group and the experimental group; all the patients were treated with the oral administration of “Yangxue Ruanjian Capsule,” Chinese herbal fumigation and washing. The experimental group additionally practiced a self-created set of Dao Yin exercises, including the forms of Pushing Eight Horses Forward, Up-and-Down Stance, Standing Stance, and Horse Stance. The JOA Functional Assessment Scale of Knee Joints and VAS were used to evaluate the effects, and the results of the two groups obtained by statistical comparison were significantly different (P < 0.01). It is thus concluded that the addition of Dao Yin exercise to conventional basic treatment has significant therapeutic effects on knee arthritis.
In two more recent studies [52, 53], Liu and colleagues compared the effect of Tai Chi, Baduanjin, and cycling in patients with knee OA and found (1) all three exercises can relieve pain symptoms and increase serum programmed cell death protein 1 (PD-1) levels and (2) different exercises can modulate both common and unique brain pathways.
6.3. Therapeutic Effects of Dao Yin Exercise on Cervical Spondylosis
There is evidence that cervical spondylosis is becoming an increasingly common disease among more and more young people, and that, in the next 50 years, it will be become a clinically important disease similar to low back pain. People who work at the desk for long hours have their neck muscles in a long-term state of tension without enough relaxation, resulting in decreased elasticity of the muscles and thereby leading to adhesion. Tissue adhesion irritates and oppresses the nerves of the spot, which causes pain. The slow-paced stretching of Dao Yin exercise promotes blood circulation, increases blood supply to the neck, and brings about benefits to nutrition and recovery. There are certain research results, indicating the clinical efficacy of Dao Yin exercise on cervical spondylosis.
In the controlled trials conducted by Jing et al. [54], 120 patients who were diagnosed with cervical spondylosis and met the trial inclusion criteria were taken as research subjects and randomly divided into the control and the experimental groups, each consisting of 60 patients. Both groups were treated with spinal manipulation in a lying position, while the experimental group additionally received Dao Yin therapy. The results showed that there was significant statistical difference before and after the treatment of each group and between the two groups after the treatment; compared with pure spinal manipulation, its combination with Dao Yin exercise yielded more significant clinical therapeutic effects on cervical spondylosis.
By conducting a prospective cohort study, Zhu et al. [55] researched into the prevention and treatment of cervical spondylosis by cervical-vertebra Dao Yin exercise and health education. The so-called cervical-vertebra Dao Yin exercise refers to the movements of leftward-rightward and forward-backward stretching of the cervical vertebra, chest expanding, and body stretching against the cervical vertebra. Healthy software professionals were selected as the research subjects. Those in the intervention group practiced cervical-vertebra Dao Yin exercise and received health education, while the control group received no intervention. Over the course of 3 years, the incidence rates were observed in both groups, with a statistically significant difference in the incidence rates between the two groups (P < 0.01); the risk of cervical spondylosis in the control group was significantly higher than that in the intervention group.
By using the random number table, Wang et al. [56] randomly divided 60 patients with cervical spondylosis, who were treated in hospital, into the treatment group and the control group, each consisting of 30 patients. Those in the control group were treated with manipulation therapy once every other day, that is, 3 times a week, for three consecutive weeks. In addition to the treatment in the control group, those in the treatment group were further treated with cervical-vertebra Dao Yin exercise twice every day (once in the morning and once in the evening), 5 days a week for three consecutive weeks. Significant improvement was found in the treatment group compared with the control group (P < 0.05).
6.4. Therapeutic Effects of Dao Yin Exercise on Heart Diseases
Practicing Dao Yin exercise also has positive effects on improving the cardiovascular and immune functions of middle-aged and elderly women. Based on a scrutiny of literature, it is found that different forms of Dao Yin exercise produce different curative effects on heart disease. For example, practicing Liu Zi Jue strengthens the internal functions of the human body, and in the process of breathing exercise, the potential ability of the viscera can be fully triggered and mobilized to resist the invasion of illness and prevent cardiovascular and cerebrovascular disease that may occur with the increase of people’s age [57, 58]. With the slowness and continuity of its movements, practicing Wu Qin Xi not only increases blood volume of venous return but also strengthens myocardial contractility to a certain degree, thereby enhancing the pumping force of the heart in the long run [59]. As both traditional Chinese and Western medicine attaches great importance to kinesitherapy in cardiac rehabilitation, existing research demonstrates that Dao Yin exercise, as a specific form of kinesitherapy in traditional Chinese medicine, produces significant benefits to the rehabilitation of heart disease.
In the article “Clinical Application of Strengthening Yang Guidance in the Cardiac Rehabilitation” by Li et al. [3], it is believed that Dao Yin exercise (referred to as “Guidance” by Li et al.) emphasizes the integration of the dynamic and the static which aims to regulate one’s body, breathing, and mind. These “three regulations” will contribute to the balance of autonomic nerves, relieve the stress of sympathetic nerves, and allow the heart rate, cardiac output, and blood pressure to have a modest adjustment, thus yielding positive effects on the prevention and adjuvant treatment of cardiovascular disease. It was proposed that long-term practice of this method could elevate the spirits and emotions of a patient, reduce mental stress, and promote emotional stability.
Xi and Wang [60] took 80 middle-aged and elderly women as the research subjects, who were randomly divided into the exercise group (n = 40, 2 dropout cases) and the control group (n = 40 patients); the patients in the exercise group practiced exercise together 3 times a week, one hour each time, for a total of 20 weeks, while the control group did no physical exercise. Before and after the 20-week experiment, each subject’s cardiovascular function indicators, IgA, IgG, and IgM were tested, respectively. The test results suggested that, after 20 weeks of exercise, the exercise group showed different degrees of decrease in heart rate (HR), pulse pressure (PP), systolic pressure (SP), diastolic pressure (DP), significant increase (P < 0.05) in stroke volume (SV), cardiac output (CO), stroke index (SI), and cardiac index (CI), and nonsignificant increase (P > 0.05) in the IgM level. After 20 weeks of experiment, the control group showed no significant difference (P > 0.05) in all indicators.
6.5. Therapeutic Effects of Dao Yin Exercise on Central Nervous System Disorders
The central nervous system, which consists of the brain and the spinal cord, serves as the major part of the human nervous system. Information from all parts of the body is received, integrated, and processed by the central nervous system into different coordinated activities or stored in the central nervous system to be the neural basis of learning and memory [61]. The treatment of motor dysfunction caused by central nervous cellular necrosis should firstly focus on the functional recovery of central nervous cells. For instance, foot drop in the cases of stroke and cerebral palsy happens due to tibialis anterior palsy and plantar flexion caused by the loss of voluntary movement of tibialis anterior controlled by the brain following the injury of the contralateral brain motor centre or conduction path [62].
Research conducted by Zhao et al. [63] reveals that the regulation of form, in addition to the regulations of spirits and breathing in traditional Chinese medicine, requires patients to concentrate on the performance of specific movements. In line with the principle of “skillful use-dependence” to promote the plasticity of the central nervous system, this process brings about greater benefits to the functional reorganization of the central nervous system and the recovery of motor function.
Peng Master’s thesis “Clinical Study on Hemiplegia Treatment by Traditional Dao Yin Exercise Combined with Modern Kinesitherapy” [64] suggests that rehabilitation techniques that integrate traditional Chinese medicine with Western medicine produce beneficial effects on the treatment of hemiplegia, especially old hemiplegia, and the technique used in traditional Chinese medicine here is Dao Yin exercise. Peng Yue believes that reasonable practice of Dao Yin exercise based on specific conditions will help to establish a correct exercise model, thereby preventing and curing diseases, enhancing physical fitness, and accelerating rehabilitation. During the recovery of brain injury, Dao Yin exercise may soothe nerves, reduce intracranial pressure, and cure edema in the acute phase, and during the chronic convalescence, it may contribute to the formation of cerebral collateral circulation as well as the reestablishment of foci of excitation in the central nervous system.
These evidences suggest that Dao Yin exercise has remarkable therapeutic effects on central nervous system disorders, especially hemiplegia and related diseases. Practicing Dao Yin exercise can better develop and functionally reorganize the central nervous potential, thereby effectively promoting recovery.
6.6. Therapeutic Effects of Dao Yin Exercise on Immune Dysfunction
Immunity refers to the physiological balanced state of an organism having an immune system to tell itself from unwanted biological invasion and to defend against antigenic foreign matters through immune responses. With the increase in age, middle-aged and elderly people are subject to rapid decline in immune function, becoming more likely to be infected by various pathogens and inflicted with tumours and immune diseases. Effective practice of physical exercise keeps biological function in a normal state, enhances cognition, self-care, activity, and other abilities of the elderly, and improves their quality of life, thus delaying the process of aging [65].
The article “Effect of Health Qigong Mawangdui Daoyin on NK Cell of Old and Middle-aged Women” by Wang et al. [4] probes into the effect of Dao Yin exercise on improving immune function of middle-aged and elderly women. The researchers believe that long-term regular practice of Mawangdui Dao Yin exercise can alleviate tension caused by autonomic response, and that the decline of autonomic nervous activity can improve cell-mediated immunoregulation function as well as increase the quantity and viability of immune cells.
Yu and Wang [65] observed the changes of T lymphocytes in the peripheral blood of 100 healthy middle-aged and elderly people before and after their 6-month practice of Wu Qin Xi, a form of health Qi Gong. After 6 months, compared with baseline levels, the male subjects in the experimental group had significantly decreased CD8+ and significantly increased the ratio of CD4+/CD8+ (P < 0.05); the male subjects in the control group had significantly decreased CD8+ (P < 0.05); the female subjects in the experimental group had significantly increased CD3+ (P < 0.05), significantly decreased CD8+, and significantly increased the ratio of CD4+/CD8+ (P < 0.01). The research results indicate that the 6-month practice of Wu Qin Xi produced positive effects on T lymphocytes in the peripheral blood of middle-aged and elderly people; therefore, such exercise has a regulatory effect on the immune balance of the middle-aged and elderly.
6.7. Therapeutic Effects of Dao Yin Exercise on Psychological Illness
Psychotherapy is a form of Dao Yin exercise requiring thoughtless awareness during the practice, which is actually an active psychological adjustment exercise. Dao Yin exercise attaches importance to mental tranquilization and proper language induction, which allow the exerciser to adjust emotions, smooth the internal paths for qi movement, and thus return to the normal state with all annoyances eliminated and all cares forgotten [29]. Furthermore, existing research has demonstrated that traditional Chinese Dao Yin exercise simultaneously improves the physiological and psychological functions of the human body, and that its influences on these two functions are interdependent and mutually restrictive [3].
Li et al. [3] believed that long-term active practice of Dao Yin exercise can help a patient to adjust the mind, relive spiritual tension, improve emotional stability, and reduce psychological stress, thereby maintaining mental health.
Liu et al. [66] selected 80 healthy women as research subjects and conducted a controlled experiment using the Self-Generate Physiological Coherence System (SPCS). The subjects were divided into the control group (those who had no recent exercise habits) and the experimental group (those who had no recent exercise habits but had begun to learn Mawangdui Dao Yin exercise recently), each group consisting of 40 subjects. During the experiment, those in the control group had irregular practice of physical exercise, while those in the experimental group learned and practiced Mawangdui Dao Yin exercise. Their emotional and physiological indicators were analysed through the SPCS, and significant changes were found in the frequency- and time-domain indicators (mean heart rate, mean-square deviation of normal PR interval, and high frequency power) of the experimental group. Thus, it was concluded that the practice of Mawangdui Dao Yin exercise can improve and ease the emotions of middle-aged and elderly women.
Ma et al. [67] randomly divided 80 middle-aged and elderly female subjects into the exercise group and the control group, each consisting of 40 subjects. After the experiment started, the subjects in the exercise group were aggregated and trained in Mawangdui Dao Yin exercise three times a week, one hour each time, for 20 weeks; those in the control group did not participate in any group or individual planned physical exercise. By applying the Profile of Mood States (POMS) Scale [68] and the Self-Rating Anxiety Scale (SAS) [69] questionnaire surveys on the subjects before and after the 20-week experiment, the researchers found significant difference (P < 0.01) in the exercise group with regard to the subjects’ stress, anger, fatigue, depression, energy, sense of dignity, total scores, average total scores, good-quality average scores, and bad-quality average scores before and after their 20-week exercise. All the indicators and scores of the control group showed no significant difference (P > 0.05) before and after the experiment.
Wan [70] researched into the physical appearance, sense of happiness, sense of sadness, and psychological stress of the sophomores at Huaiyin Normal University in Jiangsu Province in a study utilizing the practice of Ba Duan Jin. Through questionnaire surveys before and after their 8-week practice of Ba Duan Jin, Wan found evidence that the practice of Ba Duan Jin played a significant role in the promotion of students’ psychological health.
Liu et al. [71] randomly selected 69 patients having type 2 diabetes mellitus (T2DM) with symptoms of depression from a community in Beijing and divided them into two groups. Using the self-rating depression scale (SDS) [72] and the quality-of-life scale for patients with type 2 diabetes mellitus (DMQLS) [73], the two groups of patients were assessed with regard to their symptoms of depression and quality of life before and after their 12-week practice of Ba Duan Jin. Meanwhile, their venous blood was collected to test the level of glycosylated haemoglobin (HbA1c). As suggested by the research results, long-term regular practice of Ba Duan Jin can effectively relieve the depression symptoms of T2DM patients and improve their quality of life, especially in the aspects of psychology and sense of satisfaction. The results also indicated the benefit of having kept the blood glucose of patients at a stable level.
Zhong et al. [74] selected 74 women with climacteric syndrome as research subjects, whose physical and mental states were evaluated by the SCL-90 [75] and Kupperman index [76] before and after their 6-month practice of Yi Jin Jing. Based on the comparison of their conditions before and after the 6-month course, it was found that the practice of Yi Jin Jing can effectively relieve the physical and mental symptoms of menopause.
Revised from Dao Yin (a.k.a. Qigong): Origin, Development, Potential Mechanisms, and Clinical Applications) X.r. Chen, et.al., 2019