Scientific Qi Exploration-Qigong and the Lymphatic System

Scientific Qi Exploration

Qigong and the Lymphatic System

by Martin Eisen, Ph.D.

1.  Lymph

The tissues of the body are supplied by minute arterial capillaries, bringing oxygen-rich blood and nutrients to cells by means of fluid, similar to blood plasma, called interstitial fluid, leaking from these vessels into the surrounding tissue.  In turn, the cells expel cell metabolites and secretions, including hormones and metabolites, into the interstitial fluid. In addition to solutes, the interstitial fluid can contain particulate matter escaping from the capillaries and also material from the extravascular connective tissue through which it diffuses.

Venous capillaries remove carbon dioxide-rich blood and cell secretions from the tissues. Ordinarily, about 30 liters of interstitial fluid will leave the arterial capillaries every day, but only 27 liters of fluid will return to the venous capillaries. Lymphatic vessels function to drain this excess fluid from the tissues as lymph and return it to the blood.

Since lymph is the interstitial fluid that flows into the lymphatics, it has a similar composition to the tissue fluid in the body from which the lymph flows, as indicated in Table 1.

Table 1. Lymph Protein Concentration

Before a meal, lymph is transparent, usually slightly yellow, because of the presence of red cells.  After a meal it appears milky from the presence of minute fat globules.  The lymphatics in the intestines appear as fine white lines passing from the mucosa to the mesentery.  These are called lacteals and their contents chyle.

Only a small fraction of dietary fats contain short chain fatty acids which can be absorbed directly into the portal blood and so enter the bloodstream.  Most common dietary fats are triglycerides, consisting of molecules formed by the condensation of three molecules of fatty acids and a molecule of glycerol.  In digestion, a reaction involving cellular enzymes, produces three molecules of the fatty acid and a molecule of glycerol.  Then, on passing through the intestinal cells, they are re-synthesized into new molecules of triglycerides.  These enter the lacteals as minute droplets called chylomicrons. The chyle flows up to the thoracic duct, a lymphatic vessel, which empties into the venous blood at the juncture of the subclavian and jugular veins.  Then, the chylomicrons are transported in the blood to be utilized by cells (1, 2).

2.  Lymphatic vessels

Nearly all bodily tissues have lymphatic channels draining excess fluid from the interstitial spaces.  Exceptions include superficial portions of the skin, the central nervous system, deeper parts of the peripheral nerves, endomysium of muscles, and bones.  Nevertheless, these tissues have tiny interstitial vessels through which interstitial fluid can flow.  Eventually, this fluid reaches the lymphatic channels running next to the boundary of these tissues.  In the brain, these minute vessels empty into the cerebrospinal fluid and thence directly into the blood.

Lymphatic vessels originate as tiny hair-like capillaries in the interstitial spaces between cells. In order to leave the tissues, the lymph must enter the lymphatic system through specialized lymphatic capillaries. Approximately 70 percent of these are superficial capillaries, located near or just under the skin. The remaining 30 percent, known as deep lymphatic capillaries, surround most of the body’s organs.

Lymphatic capillaries begin as blind-ended tubes that are only a single cell in thickness (Fig. 1). These cells are arranged in a slightly overlapping pattern, like the shingles on a roof. Each individual cell is fastened to nearby connective tissues by an anchoring filament.  This helps the tiny capillaries from collapsing under outside pressure, preventing lymph flow.

As illustrated in Fig. 1, pressure from the fluid surrounding the capillary will separate the cells allowing lymph to enter the capillary. Then, the cells of the wall are forced together, because of the inside pressure preventing lymph from leaving the capillary end bulb. Instead, lymph is forced to move through the valve on the right as shown in Fig. 1.

Figure 1.  End of a lymphatic capillary

The lymphatic capillaries gradually merge to form a mesh-like network of tubes that are located deeper in the body. As they become larger, these structures are known as lymphatic vessels.

Deeper within the body the lymphatic vessels become progressively larger and are located near major veins.  Like veins, lymphatic vessels, which are known as lymphangions, have one-way valves to prevent any backward flow (Fig. 2).  Each angion is a segment created by the space between two sets of valves.

Figure 2.  Lymphangions

Smooth muscles in the walls of the lymphatic vessels cause the angions to contract sequentially to aid the flow of lymph toward the thoracic region.

All of the lymphatic vessels, see Fig. 3, eventually converge into either the thoracic duct or the right lymphatic duct. The thoracic duct is about 45 cm long and forms the largest confluence of lymphatic vessels in the body. It receives lymph from the left side of the body as well as the lower right side. It originates at the cisterna chyli, a small pouch that lies on the surface of L2. From here the thoracic duct ascends the thorax, lying to the left of the vertebral column. It then joins with vessels from the neck and empties into the left subclavian vein at its junction with the left internal jugular vein.

The right lymphatic duct is much shorter than the thoracic duct and may only be 1 cm long. It is formed by the confluence of several lymphatic vessels, which drain the right side of the head and thorax, and the right arm. It drains into the junction of the right subclavian and right internal jugular veins.

Figure 3.  Lymphatic vessels

Lymphatic drainage is organized into two separate and very unequal drainage areas. These are the right and left drainage areas, as shown in Fig. 4.  Normally lymph does not drain across the invisible lines that separate these areas.

Figure 4.   Lymphatic Drainage Areas.

The right drainage area drains lymph from the right side of the head and neck, the right arm, and the upper right quadrant of the body.  Lymph from this area flows into the right lymphatic duct and empties the lymph into the right subclavian vein.

The left drainage area drains lymph from the left side of the head and neck, the left arm, the left upper quadrant, the lower trunk and both legs.  The cisterna chyli temporarily stores lymph as it moves upward from the lower areas of the body.  The thoracic duct transports lymph upward to the left lymphatic duct, where it empties the lymph into the left subclavian vein.

If lymphatic tissues or lymph nodes have been damaged or removed, lymph cannot drain normally from the affected area.  Then excess lymph accumulates, resulting in the swelling that is characteristic of lymphedema.   If bacteria enter this stagnant fluid through a break in the skin, they can thrive on this protein-rich fluid.  This is the reason that lymphedema frequently results in infections.

Treatment of lymphedema is based on the natural structures and the flow of lymph. The affected drainage area determines the pattern of the special manual lymph drainage (MLD) and for self-massage. Although lymph does not normally cross from one area to another, MLD stimulates the flow from one area to another. It also encourages the formation of new lymph drainage pathways.

MLD treatment and self-massage begin by stimulating the area near the terminus of the larger lymphatic vessels (5), because any accumulated fluid would block the one-way flow.  The rhythmic, light strokes of MLD provide just the right pressure to encourage this excess lymph to flow into the lymph capillaries.

Compression bandages are worn between treatments to help control swelling by providing needed pressure, which encourages the flow of lymph into the capillaries.  Exercise is important in the treatment of lymph since muscle movements stimulate the flow of the lymph into the capillaries. Wearing a compression garment during exercise also helps to further stimulate the flow.

3.  Functions of the lymphatic system

The lymphatic system has four main functions, to maintain fluid balance, to defend the body against disease by producing lymphocytes, to absorb fats from the intestine and transport them to the blood and to transport proteins.

(i)  Fluid balance has been described above.

(ii)  Defense

Lymphatic vessels empty the tissue fluid into the lymph nodes before returning it back to the blood steam. It is here that any foreign cells, e.g.:  viruses, bacteria, dead blood cells, cancer cells, fungi or chemicals which are harmful to the body (pathogens), are detected and removed by lymphocytes (white blood cells) which congregate in the lymph nodes.  Once a foreign microorganism has been detected, an immune response is triggered and the lymphocytes in the lymph node multiply.

(iii)  Digestion of fats

Some fats are too large to pass through the capillary walls of the small intestine and therefore cannot be absorbed (1, 2). Lymphatic vessels known as lacteals can absorb these large fats and transports them into the venous circulation via the thoracic duct. When the lymph contains fat it becomes milky and is known as chyle.

(iv) The lymphatic system also works with the circulatory system to deliver nutrients, oxygen, and hormones from the blood to the cells that make up the tissues of the body.

(v) Transportation of Proteins

Proteins leak continuously from the capillaries into the interstitial fluid spaces.  It must be removed continually to prevent the tissue colloid osmotic pressure from becoming so high that the capillaries would collapse and normal flow through the capillaries would be blocked.  You would die in a few hours!

However, only a small proportion of the leaked proteins can diffuse back into the capillaries, since there is about four times the amount of protein in the plasma than in the interstitial fluid.  Fortunately, the leaked protein is removed by the lymphatic system as follows:

Small quantities of proteins are carried by the fluid which leaks from the arterial ends of the capillaries into the interstitial spaces.  As fluid is reabsorbed at the venous ends of the capillaries most of the protein is left behind.  Consequently, protein accumulates progressively in the interstitial fluid.  This increases the tissue colloid osmotic pressure.  The higher osmotic pressure decreases the reabsorption of fluid by the capillaries.  Therefore, tissue fluid will be increased, which increases tissue pressure.  The increased pressure will then force fluid containing the excess proteins into the lymphatic channels.  This washes the proteins out of the tissues spaces, returning the protein concentration to its normal low level (1).

4.  Lymphatic Cells

Lymphatic cells consist of T and B cells, macrophages (1, 3, 4) and reticular cells. Reticular cells and their reticular fibers made from Type III collagen and glycoproteins provide a network within which the lymphocytes and other cells reside.

5.  Lymphatic Tissue

Lymphatic cells are organized into tissues, which are classified by how tightly the lymphatic cells are arranged.  Organs are formed when the tissue is encapsulated by a layer of connective tissue and will be discussed in Section 6.

(i)  Diffuse bundles of lymphatic cells

This kind of lymphatic tissue consists of lymphocytes and macrophages associated with a reticular fiber network. It occurs in the lamina propria (middle layer) of the mucus membranes (mucosae) that line the respiratory and gastrointestinal tracts.

(ii)  Discrete bundles of lymphatic cells.

These bundles are called lymphatic nodules (follicles).  They have clear boundaries which separate them from neighboring cells. Nodules occur within the lamina propria of the mucus membranes that line the gastrointestinal, respiratory, reproductive, and urinary tracts and are referred to as mucosa-associated lymphoid tissue (MALT). The nodules contain lymphocytes and macrophages for protection against bacteria and other pathogens that may enter these passages with air, food, or urine.

Nodules can occur as solitary nodules or cluster as patches or aggregates. Peyer’s patches are clusters of lymphatic nodules that occur in the mucosa that lines the ileum of the small intestine.

The tonsils are aggregates of lymphatic nodules that occur in the mucosa that lines the pharynx (throat). Each of the seven tonsils that form a ring around the pharynx are named for their specific region: A single pharyngeal tonsil (adenoid) in the rear wall of the nasopharynx, two palatine tonsils on each side wall of the oral cavity at its entrance in the throat, two lingual tonsils at the base of the tongue, and two small tubal tonsils in the pharynx at the entrance to the auditory tubes.

The appendix, a small attachment at the beginning of the large intestine, is lined with aggregates of nodules. Encapsulated organs contain lymphatic nodules and diffuse lymphatic cells surrounded by a capsule of dense connective tissue. The three lymphatic organs are discussed in the following sections.

6.  Lymphatic Organs

Encapsulated lymphatic tissue form several types of organs.

(i) Lymph nodes

Lymph nodes are small, bean-shaped bodies that occur along lymphatic vessels.  They are abundant where lymphatic vessels merge to form trunks, especially in the inguinal (groin), axillary (armpit), and mammary gland areas.  There are between 600 to 700 nodes present in humans.  Damaged or destroyed lymph nodes do not regenerate.

Lymph flows into a node through afferent lymphatic vessels that enter the convex side of a node. It exits the node at the hilum, the indented region on the opposite, concave side of the node, through efferent lymphatic vessels. Efferent vessels contain valves that restrict lymph to move only out of the lymph node.  Fewer efferent vessels leave the lymph node than the number of entering, afferent vessels.  This slows the flow of lymph through the node and so allows more time for the nodes to do their work.  Lymph nodes perform three functions:

(a)  They filter the lymph, preventing the spread of microorganisms and toxins that enter interstitial fluids.

(b)  They destroy bacteria, toxins, and particulate matter through the phagocytic action of macrophages.

(c)  They produce antibodies through the activity of B cells.

Lymph nodes have the following structural features.  A capsule of dense connective tissue surrounds the lymph node.  Projections of the capsule, called trabeculae, extend into the node forming compartments. The trabeculae support reticular fibers forming a network that supports lymphocytes.  The cortex is the dense, outer region of the node. It contains lymphatic nodules where B cells and macrophages proliferate.  The medulla, the center of the node, is less dense than the surrounding cortex, and contains mostly T cells.  Medullary cords are strands of reticular fibers with lymphocytes and macrophages that extend from the cortex toward the hilum.  Sinuses are passageways through the cortex and medulla through which lymph moves toward the hilum.

(ii)  Thymus

The thymus has two lobes and is located in the upper chest between the lungs. It grows during childhood and reaches its maximum size of 40 grams at puberty.  Then, its size slowly decreases as it is replaced by adipose and areolar connective tissue. Around age 65, it only weighs about 6 grams.  Each lobe of the thymus is surrounded by a capsule of connective tissue. Lobules produced by trabeculae (inward extensions of the capsule) are characterized by an outer cortex and inner medulla. It is composed of the following types of cells:

(a)  Lymphocytes, which are almost all T cells.

(b) Epithelial-reticular cells resembling reticular cells, but they do not form reticular fibers. Instead, these star-shaped cells form a reticular network by interlocking their slender cellular processes forming extensions. These extensions are held together by desmosomes, cell junctions formed by protein fibers. Epithelial-reticular cells produce thymosin and other hormones believed to promote the maturation of T cells.

(c)  Thymic (Hassall’s) corpuscles are dense, concentric layers of epithelial-reticular cells. Their function is unknown.

The function of the thymus is to promote the maturation of T lymphocytes.  Mature T cells leave the thymus by way of blood vessels or efferent lymphatic vessels, migrating to other lymphatic tissues and organs where they become active in immune responses (3).

The thymus does not provide a filtering function similar to lymph nodes (there are no afferent lymphatic vessels leading into the thymus), and unlike all other centers of lymphatic tissues, the thymus does not play a direct role in immune responses.

Blood vessels that permeate the thymus are surrounded by epithelial-reticular cells. These cells establish a protective blood-thymus barrier that prevents the entrance of antigens from the blood and into the thymus where T cells are maturing. Thus, an antigen-free environment is maintained for the development of T cells.

(iii)  Spleen

The spleen is about 12 cm (5 in) in length and is the largest lymphatic organ. It is located on the left side of the body between the diaphragm and stomach.  Its surrounding capsule extends into the spleen forming trabeculae. The splenic artery, splenic vein, nerves, and efferent lymphatic vessels pass through the hilum of the spleen located on its slightly concave, upper surface.

The spleen is composed of two distinct areas.  The white pulp consists of reticular fibers and lymphocytes in nodules that resemble the nodules of lymph nodes.  The red pulp consists of venous sinuses filled with blood. Splenic cords consisting of reticular connective tissue, macrophages, and lymphocytes form a mesh between the venous sinuses and act as a filter as blood passes between arterial vessels and the sinuses.

Some functions of the spleen are:

(a)  It filters the blood. Macrophages in the spleen remove bacteria and other pathogens, cellular debris, and aged blood cells. There are no afferent lymphatic vessels and, unlike lymph nodes, the spleen does not filter lymph.

(b)  It destroys old red blood cells and recycles their parts by removing the iron from heme groups and binding the iron to the storage protein.

(c)  The red pulp retains large quantities of blood, which can be directed to the circulation when necessary. One third of the blood platelets are stored in the spleen.

(d)  The spleen is active in immune responses. T cells proliferate in the white pulp before returning to the blood to attack foreign cells.  B cells proliferate in the white pulp, producing plasma cells and antibodies that return to the blood to inactivate antigens.

(e)  Red and white blood cells are produced in the spleen during fetal development.

5.  Diseases of the Lymphatic System

(a)  Lymphedema

The most prevalent lymphatic disorder is lymphedema. This is an accumulation of lymphatic fluid in the interstitial tissue causing swelling. This can lead to cellulitis (deep skin infections) and if untreated, can spread systemically or require surgical intervention. It is a lifelong functional problem requiring daily treatment.  Eventually the skin becomes fibrotic (thickening of the skin and subcutaneous tissues) with loss of normal architecture, function and mobility.

Primary Lymphedema is an inherited condition in approximately 0.6% of live births. The lymphatic vessels are either missing or impaired and can affect all parts of the body.  It can be present at birth, develop at the onset of puberty or present in adulthood, with no apparent causes. Other lymphatic diseases include lipedema, cystic hygromas, lymphangiomas, lymphangiectasias, lymphangiomatosis and other mixed vascular/lymphatic malformation syndromes and conditions, such as Turner-Weber and Klippel Trenauney Syndrome.

Secondary Lymphedema (acquired regional lymphatic insufficiency) is a common problem among adults and children in the United States. It can occur following any trauma, infection or surgery that disrupts the lymphatic channels or results in the loss of lymph nodes.  Secondary lymphedema occurs in approximately 30% of breast cancer survivors.  Lymphedema  can also result from prostate, uterine, cervical, abdominal, orthopedic cosmetic (liposuction) and other surgeries, malignant melanoma, and treatments used for both Hodgkin’s and non-Hodgkin’s lymphoma. Radiation, sports injuries, tattooing, and any physical insult to the lymphatic pathways can also cause lymphedema. Even though lymphatic insufficiency may not immediately present at the time any of these events occur, individuals are at risk for lymphedema throughout their life.

Filariasis is a world health problem resulting from a parasitic-caused infection causing lymphatic insufficiency, and can result in elephantiasis.

(b)  Lymphoma

Lymphoma is a general term for cancers originating in the lymphatic system.  Lymphomas are classified as Hodgkin lymphoma and non-Hodgkin lymphomas. Lymphomas result from an acquired injury to the DNA of a lymphocyte occurring after birth and so is acquired rather than inherited.

(c)  Cancer and the Lymphatic System

The lymphatic system is critical to the body’s surveillance against cancer. However, the lymphatic system is also one of the most common avenues for the spread of cancer cells throughout the body. Cancer cells influence the development of new lymphatic vessels and pathways, establishing the route for these cells to spread to other parts of the body. This  mechanism of this process, known as lymphangiogenesis, remains to be discovered.

(d)  Infection/HIV and the Lymphatic System

HIV and AIDS are directly connected to the lymphatic system. The ability to effectively control HIV requires more knowledge of the lymphatics in order to understand how infectious organisms invade the lymphatic system and overcome its normal protective role.  Understanding the pathways and physiology of the lymphatics, will also increase the ability to deliver antibiotic and anti-viral medication to infected tissues and organs.

(e)  Inflammation, Auto-immunity and the Lymphatic System

Inflammatory and auto-immune diseases such as rheumatoid arthritis and systemic lupus erythematosis (SLE), scleroderma, Wegener’s granulomatosis, and others are impacted by the lymphatic system. All of these diseases are believed to be connected to an inflammatory process initiated by the body’s immune response. The lymphatic system governs the body’s immune system that normally makes the proteins, called antibodies, to protect the body against viruses, bacteria, and other foreign materials. These foreign materials are called antigens. In an autoimmune disorder such as lupus, or arthritis the immune system looses its ability to tell the difference between foreign substances (antigens) and its own cells and tissues. The immune system then makes antibodies directed against “self”. These antibodies, called “auto-antibodies”, react with the “self” antigens to form immune complexes. The immune complexes build up in the tissues and can cause inflammation, injury to tissues, and pain. A better understanding of how the system works will greatly increase the possibility of discovering treatments and cures for these diseases as well.

(f)  Digestive, Pulmonary Function, and Other Disorders

Lymphatic insufficiency of the internal organs often occurs in children born with inherited or developmental disorders of the lymphatics.  It can result in serious problems.  For example, impairment of lymphatic development in the intestines leads to malabsorption, ascites (collections of fat-laden lymph within the abdominal cavity), underdevelopment from malnutrion, immune malfunction, and premature death.  Some examples of disorders occurring in other parts of the body are: pulmonary lymphangiectasia, cystic hygromas and lymphangiomas.  Breathing and swallowing difficulties and impaired vision, are often complications resulting from these disorders.

7.  Effects of Qigong on Lymph Flow

The following are five ways that Qigong can affect lymph flow.

(a)  Aerobic Energy Production

A major component of lymph is water.  Movement and breathing oxygen requires cells to produce energy in the form of ATP (1).  Energy is produced and hydrogen atoms are released by the metabolism of glucose by the glycolytic and phosphogluconate pathways.  The hydrogen atoms are converted to water by oxidative phosphorylation which also releases energy.  Since the capacity of the tissues spaces is limited, the produced water increases the lymph volume and so forces the excess into the lymphatic vessels.

The first step in the glycolytic pathway is glycolysis, a series of 10 chemical reactions, which can be summarized by the following reaction:   a Glucose molecule plus 2ADP plus two phosphate ions are converted into 2 molecules of Pyruvic acid and ATP plus 4 hydrogen atoms.  The next step is the conversion of the 2 Pyruvic acid molecules by Coenzyme A into 2 Acetyl Co-A and 2 carbon dioxide molecules plus 4 hydrogen atoms.  The final step in this process is called the citric acid or Krebs or tricarboxylic acid cycle.

It is summarized by: 2Acetyl Co-A + 6H₂O + 2ADP à 4CO₂ + 16H + 2Co-A + 2ATP

The phosphogluconate pathway is a cyclic pathway and after several stages of cyclic conversion the net reaction is that glucose plus 6 molecules of water is converted into 6 carbon dioxide molecules and 24 hydrogen atoms.  This pathway is not the major method of the breakdown of glucose in most cells.  It is responsible for as much as 30% of the breakdown in liver cells and even more if fat cells.  It barely occurs in muscles cells.

Finally, water is produced by oxidative phosphorylation using the hydrogen atoms.  It is summarized by: 2H + 1/2O₂ + 3ADP à H₂O + 3ATP

In a moderately active 70Kg man 2100 to 2800 cc of lymph enter the blood stream daily.  Calculations based upon the above pathways show that about 950 cc of interstitial water are produced daily by the cells.  Exercise such as walking or Qigong can produce up to 1400 cc of aerobically generated interstitial water (6).

(b)  Breathing

The thoracic duct, which is a very large lymph vessel, lies above the diaphragm.  The cisterna chyli, a broad expansive vessel from which the thoracic duct originates, lies below the diaphragm.  The lymphatic tissues above and below the diaphragm contain a greater volume of lymph than other regions.

On inspiration, the diaphragm descends which increases the volume of the thoracic space and so decreases its pressure and air rushes in to fill the lungs.  The expansion of the lungs slightly compresses the thoracic duct while the downward movement of the diaphragm compresses the cisterna chili.  The lymph is forced to move upward into the subclavian vein, because of the one-way valves in the lymphatic vessels.

On expiration, the diaphragm move upward decreasing the volume of the thoracic cavity and so increasing its pressure.  Both of these effects compress the thoracic duct forcing the lymph to move upwards.

Dr. Shields (7) used moving X-ray films to study breathing patterns for various activities.  He concluded that deep inspiration pumps lymph at a much greater rate than resting respiration and other activities.

(c)  Body Position and Gravity

Inversion of the limbs or even lying down can help lymph flow because of gravitational forces coupled with the one-way valves of the lymphatic vessels.  In fact, elevation of the lower limbs and lower body is recommended for pooling of interstitial fluid in these regions.

Qigong has many different postures and movements that enable gravity to propel the lymph.

(d)  Voluntary Movement of Striated Muscles

The slightest muscular movement propels lymph because it compresses the one-way lymphatic vessels.  In Qigong, there are many different styles having movements that require contraction and relaxation of the skeletal muscles.  Various breathing methods in Qigong also increase lymph flow as explained in (b).

(e)  Involuntary Movement of Smooth Muscles

The smooth muscles in the peripheral lymphatic vessels have the autonomic response to contract if filled and stretched to a certain limit (8).  This moves the lymph along the vessels with the aid of the one-way valves.

Qigong triggers this mechanism as described in (a) through (d).  This mechanism may also be activated by the change in autonomic function caused by the relaxation response induce by Qigong.

Many articles and books state that Qigong has beneficial effects on the lymphatic system.  However, there is usually no justification.  Dr. Jahnke (9) gives a detailed explanation and references as well as the effects of Yoga.

8.  Qigong and Diseases of the Lymphatic System

Qigong techniques such as breathing are recommended for filariasis in (9).  Filarisis and other immunological stressors may lead to Aids (10).  Qigong is recommended as a prevention and treatment of Aids in the same paper.

The Qigong treatment of lymphedema and cancers of the lymphatic system can be found in (11) and (12).

References

1.  Guyton, A.C.  Textbook of Medical Physiology.  W. B. Saunders Co., Philadelphia, 1971.

2.  Eisen, M.  Scientific Qi Exploration.  Part 14.  Qigong’s Effects on Blood and its Biochemical Constituents.  Qi Dao, June, 2011.

3.  Eisen, M.  Scientific Exploration of Qi:  Part 13a:  Qigong and the Immune System — The Innate Immune System.  Qi Dao, Sept./Oct., 2010.

4.  Eisen, M.  Scientific Exploration of Qi:  Part 13b:  Qigong and the Immune System.  The Adaptive Immune System.  Nov./Dec., 2010.

5.  Lymphatic Drainage Massage Therapy: http://www.youtube.com/watch?v=XvGqGRecMt0

6.  Shields, J.W.  The aerobic production and central propulsion of lymph.  Proc. Of the 12th Int. Congress of Lymphology, Tokyo, Japan, Sept., 1999.

7.  Shields, J.W.  Human central lymph propulsion.  J. Amer. Med. Ass., 18, 246, 1981.

8.  Olszewski, W.L.  Lymphatic contractility.  New England J. of Med., 316, 300, 1979.

9.  Vaqas, B and Ryan, T.J.  Lymphoedema: Pathophysiology and management in resource-poor settings – relevance for lymphatic filariasis control programmes.  Filaria J., March 12,2(1):4, 2003.

10.  Giraldo, R.   Immunological stressors agents are the real cause of Aids.  Lecture at “The HIV/AIDS problem and the family well-being of the Nation” organized by the “Russian Parent Assembly”, Ekaterinburg, Russia, May 29- 30, 2008.

11.  Johnson, J.A.  Chinese Medical Qigong Therapy, Volumes 4, International Institute of Medical Qigong, 2006.

12.   Johnson, J.A.  Chinese Medical Qigong Therapy, Volumes 5, International Institute of Medical Qigong, 2005.

[Dr. Eisen is a retired scientist, who constructed mathematical models in medicine. He has studied and taught Judo, Shotokan Karate, Aikido, Qigong, Praying Mantis Kung Fu, and Tai Chi in different places.  He took correspondence courses in Chinese herbology and studied other branches of Chinese medicine with a traditional Chinese medical doctor.  He was the Director of Education of the Chinese Medicine and Acupuncture Institute in Upper Darby, P.A.]