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sabato 27 novembre 2010

Benchmarks for training in naturopaty

Cari amici, con immenso piacere vi comunico che l’ Organizzazione Mondiale della Sanità (WHO) ha pubblicato con codice ISBN 978 9215996 5 8 le linee guida di riferimento per la formazione in naturopatia “Benchmarks for training in naturopaty”.
In questa pubblicazione sono indicate le materie di insegnamento e le ore di formazione che ogni persona ,intenzionata ad impegnarsi in questo delicato e appassionante lavoro, deve svolgere per conseguire il titolo di naturopata e potere esercitare con diritto questa disciplina. Un ulteriore passo in avanti per la definizione dei ruoli e delle prerogative della Naturopatia a livello mondiale che speriamo venga seguito da altrettanti passi in avanti a livello nazionale .

Riporto di seguito alcuni stralci significativi di questo importante documento per la naturopatia mondiale.

As more people turn to complementary and alternative health care to meet their
various health-care needs, the use of naturopathic approaches continues to grow
in popularity (1,2,3). This document begins with a brief overview of the
naturopathic profession, including a discussion of terminology, followed by a
summary of the principles that inform naturopathic practice. It is recognized that
naturopathic practice may include additional roles, including the distribution of
naturopathic products. However, these additional roles are considered beyond
the scope of this document, which aims only to outline benchmarks for the
training of practitioners, considered adequate by the community of practitioners,
experts and regulators of naturopathy.
In general, naturopathy emphasizes prevention, treatment and the promotion of
optimal health through the use of therapeutic methods and modalities which
encourage the self-healing process – the vis medicatrix naturae. The philosophical
approaches of naturopathy include prevention of disease, encouragement of the
body's inherent healing abilities, natural treatment of the whole person, personal
responsibility for one's health, and education of patients in health-promoting
lifestyles. Naturopathy blends centuries-old knowledge of natural therapies with
current advances in the understanding of health and human systems.
Naturopathy, therefore, can be described as the general practice of natural health
This document provides benchmarks for basic training of practitioners of
naturopathy; models of training for trainees with different backgrounds; and a
review of what the community of practitioners of naturopathy considers as
contraindications, so as to promote safe practice of naturopathy and minimize
the risk of accidents. Together, these can serve as a reference for national
authorities in establishing systems of training, examination and licensure which
support the qualified practice of naturopathy.
Benchmarks for training in naturopathy

1. Origin and principles of naturopathy
Many of the philosophical principles that underpin naturopathic practice can be
traced to the teachings of Stoicism in ancient Greece and the practice of medicine
in the Hippocratic schools. In addition to these ancient roots, naturopathic
practice emerged from an amalgamation of the philosophy, techniques, science
and principles that typified the alternative healing systems of the eighteenth and
nineteenth centuries, particularly those related to vitalism (4). These alternative
approaches tended to focus both on health promotion and on health-care regimes
that supported the patient’s innate healing processes.
Some of the founding influences that defined naturopathic philosophy and
practice include (5,6):
• the hydrotherapy techniques of Vincent Priessnitz (1799-1851) and Father
Sebastian Kneipp (1821-1897) in Europe, and John Harvey Kellogg (1852-
1943) in North America;
• the Thomsonian method of Samuel Thomson (1769-1843) that
foreshadowed physiomedicalism, from which some forms of modern
phytotherapy emerged;
• the nature cure methods of Dr Louis Kuhne (1823-1907), Dr Arnold Rickli
(1823-1926), and Dr Henry Lindlahr (1862-1924) that emphasized healthy
lifestyles, sunlight and fresh air, vegetarianism and detoxification;
• homeopathy, derived by Christian Friedrich Samuel Hahnemann (1755-
• the Eclectic school of medicine of Dr Wooster Beach (1794-1868), which
employed botanical medicines;
• the philosophy of vitalism, which maintained that the body has an innate
intelligence that strives constantly for health, so that the practitioner’s role
is to assist these efforts by cooperating with the healing powers of nature
active within the body;
schools of manipulative therapies, such as osteopathy, developed by
Dr Andrew Taylor Still (1828-1917), and chiropractic, developed by
Daniel David Palmer (1845-1913).
In Europe, the naturopathic approach to health care tended to evolve from the
hydrotherapy and nature cure practices that had been developed by Priessnitz,
Kneipp, Kuhne and Rickli. In North America, Dr Benedict Lust is described as
establishing naturopathy in 1902, deriving it from nature cure (7). Naturopathy
has been regulated in various regions of Europe and North America since the
1920s. The practice of naturopathy can vary widely, depending on the history of
its evolution, the legislation affecting its practice, and the demands of the public
for traditional medicine and complementary and alternative medicine
(TM/CAM) in the relevant jurisdiction.
From the mid-1960s into the 1980s, naturopathy enjoyed a renaissance as the
public in many parts of the world became disenchanted with so-called "western"
medical practices and more interested in holistic health-care practices that
Benchmarks for training in naturopathy emphasize healthy lifestyles as well as health promotion and disease prevention . Various modalities exist (see Box 1). As universities began to emphasize the need for credible research and scientific validation in every discipline and the demand for “evidence-based medicine” continued to grow, naturopathic practitioners continued their support for high academic standards and sound curricula to pursue the scientific confirmation of naturopathic methods. For instance, an international council for the accreditation of naturopathic colleges was established in North America (9) as well as a central agency to examine the graduates of naturopathic colleges (10,11). These efforts at formalizing and universalizing standards of naturopathic education and practice established new
benchmarks and intensified discussion concerning the identity of the profession.

Box 1 - Common naturopathic modalities (non-exhaustive list)
The following non-exhaustive list shows the modalities most commonly used in naturopathic practice:

• acupuncture
• botanical medicine
• counselling
• homeopathy
• hydrotherapy
• naturopathic osseous manipulation
• nutrition
• physical therapies (e.g. soft tissue massage, electrotherapy, etc.)

The principles that inform naturopathy can be summarized as follows:
• “first, do no harm”
• act in cooperation with the healing power of nature
• seek, identify and treat the fundamental cause of the illness
• treat the whole person using individualized treatment
• teach the principles of healthy living and preventive health care
While the emphasis placed on these principles can vary within naturopathy, each
version generally captures the same underlying philosophy and goals.

First, do no harm
Although a seemingly obvious statement that would be echoed by any healthcare
practitioner, the dictum attributed to the classical physician Hippocrates,
that physicians should “do no harm” to their patients, has specific resonance in
naturopathy. As in most health-care professions, investigative methods and
therapeutic modalities that do the least harm to the patient are preferred. When
other health-care approaches are required because of the patient’s illness,
naturopathic practitioners are trained to recognize this situation and to refer
patients to those who can provide the needed care (12).

Act in cooperation with the healing power of nature
The Stoics of ancient Greece believed that there was an animating principle, logos,
that acted as a vital force to order the universe. If humans used their rational
abilities to bring their behaviour into harmony with this order, they would
Origin and principles of naturopathy

flourish. Naturopathy, adopting this Stoic philosophy, recognizes that the same
power that made the body – i.e. an innate intelligence active both in the universe
and within the human body – would also heal the body unless prevented from
doing so. By working with this healing power of nature – i.e. working with the
vis medicatrix naturae of the patient – rather than trying to impose a treatment
without regard for the person’s own intrinsic ability to heal, the naturopathic
practitioner seeks to assist the body, mind and spirit of the patient to bring about
the desired healing (13).
Seek, identify and treat the fundamental cause of the illness
For every problem, there is a cause. Naturopathic practitioners are more
interested in seeking, identifying and treating the cause than in treating the
symptoms of illness. They argue that if the symptom of a disease is temporarily
eliminated or suppressed but the underlying cause is neglected, then the problem
will simply return, or could even worsen in the interim. The cause of illness must
be identified and eliminated if true healing is to occur. This often requires a
thorough examination of the patient’s lifestyle, diet and vital force (14).
Treat the whole person using individualized treatment
Naturopathic practitioners work with a holistic understanding of human health.
They recognize that humans are most likely to experience optimal health when
their physical, psychological, spiritual and environmental dimensions are
holistically integrated. People who exhibit integrated health are better able to
realize their goals and actualize their potential. They are more likely to be in
harmony within themselves, with others and with their environment. Because
each person is different, the naturopathic practitioner must individualize
treatments to meet the unique needs of each patient (15).
Teach the principles of healthy living and preventive health care
Naturopathic practitioners teach the principles of healthy living and preventive
health care. They teach patients the causes of illnesses so that the patients are
better able to avoid recurrences. Furthermore, patients should be involved in the
therapeutic process so that they can engage in their own recovery and learn to
take responsibility for their future health. This cooperative approach between the
practitioner and patient has been shown to empower the patient, which provides
further benefit. It is also more likely to engender a positive attitude in the patient,
which is believed to improve the chances of optimal recovery (16).
Benchmarks for training in naturopathy

2. Training of naturopathic practitioners
Regulating the practice of naturopathy and preventing practice by unqualified
practitioners requires a proper system of training, examination and licensing.
Benchmarks for training have to take into consideration the following:
• content of the training;
• method of the training;
• to whom the training is to be provided and by whom;
• the roles and responsibilities of the future practitioner;
• the level of education required in order to undertake training.
Naturopathy experts distinguish two types of naturopathic training in function
of prior training and clinical experience of trainees.
Type I training programmes are aimed at those who have no prior medical or
other health-care training or experience. They are designed to produce
naturopathic practitioners who are qualified to practise as primary-contact and
primary-care practitioners, independently or as members of a health-care team.
This type of programme consists of a minimum of two years of full-time study
(or its equivalent) of no fewer than 1500 hours, including no less than 400 hours
of supervised clinical training. Acceptable applicants will typically have
completed high school education or equivalent.
Type II training programmes are aimed at those with medical or other healthcare
training (western medicine, dentistry, chiropraxis, osteopathy, etc) who wish
to become recognized naturopathic practitioners. The learning outcomes should
be comparable to those of a Type I programme.
2.1 Learning outcomes of Type I programme
Graduates of the Type I programme have to be able to:
• provide a basic description of the principles and practice of the various
disciplines of traditional, complementary and alternative medicine;
• assess the health of their clients of all ages with skill and accuracy and to
communicate this information effectively to their clients;
• prescribe appropriate treatments involving naturopathic modalities used
in accordance with naturopathic principles;
• recommend traditional medicines for the purpose of treating and
preventing diseases and promoting health;
• prepare traditional medicines in accordance with pharmacopoeia
requirements and good compounding and dispensing practices;
• monitor, evaluate and adapt, when necessary, the naturopathic care of
each client;
• educate both clients and the public concerning the promotion of health
and the prevention of diseases;
Benchmarks for training in naturopathy
• refer clients to other health-care professionals when necessary and
• practise ethically and in compliance with the codes and guidelines of the
relevant professional organizations as well as the statutes, rules, laws
and/or regulations of the licensing or regulatory body.

2.2 Syllabus
The Type I programme includes four primary areas of study:
• basic sciences
• clinical sciences
• naturopathic sciences, modalities and principles
• clinical training and application.
Since some courses and disciplines overlap more than one of these areas, this
classification is merely intended to provide a simple categorization of the breadth
of courses that are studied.
Basic sciences include: anatomy, physiology, pathology.
Clinical sciences include: taking a patient history and clinical assessment;
physical examination; first-aid and emergency medicine; hygiene and public
Naturopathic sciences, modalities and principles include: naturopathic history
and practice; nature cure; nutrition; hydrotherapy; botanical medicine;
homeopathy and tissue salts; Bach flower therapy; stress management and
lifestyle counselling; ethics and jurisprudence; optional courses (light and
electrotherapy; iridology; soft tissue therapies; aromatherapy; acupuncture).
Clinical training may include preceptorship and supervised clinical training.

2.3 Competency in botanical medicine
Competency in botanical medicine requires training in core naturopathic subjects
as well as specific botanical medicine subjects. All naturopathic practitioners
receive training in the use and compounding of medicinal plants. They are
knowledgeable in the identification, storage, compounding and dispensing of
herbal remedies. These practitioners should be able to identify the herbal
remedies that are most commonly used in their region and demonstrate
knowledge of pharmacognosy and good compounding and dispensing practices.
For each of these herbal medicines, they should be able to state the indications,
dosages, contraindications, potential adverse effects, toxicity levels and potential
interactions between herbal remedies, pharmaceutical products or foods.
Practitioners should comply with requirements for adverse-reaction reporting.
By the end of the training programme, students should have the competency in
the area of botanical medicines (6) and:
Training of naturopathic practitioners

• have a basic knowledge of botany; have an understanding of the
taxonomy and morphology of botanical medicines; be able to identify
botanical medicines, both growing and dried, relevant to their level of
• be able to classify plants according to their action – e.g. as astringents,
demulcents, diaphoretics, etc. – and relate the action of an individual
plant to the indications for its use;
• understand the pharmacological action of botanical medicines;
• know in detail the dosage range and toxicities of the botanical medicines
studied in their training programme;
• know in detail the contraindications and incompatibilities of the botanical
medicines studied in their training programme;
• be able to list potentially adverse botanical-botanical, botanicalnutraceutical,
botanical-pharmaceutical and/or botanical-food
interactions for the botanical medicines used in their practice;
• have awareness of the relative merits of simple and/or complex botanical
medicine preparations;
• have an understanding of good compounding and dispensing practices
appropriate to their level of practice;
• be able to report adverse reactions to the appropriate authorities

Table 1 - Indicative Type I training programme
Year 1
Naturopathic History and Practice
Nature cure principles
Toxicity, Detoxification, Cleansing
Hygiene and public health
Psychology and stress management
First Aid, emergency care

Year 2
Anamnesis and clinical assessment
Fasting, diet, nutrition
Homeopathy & Tissue Salts
Bach Flower Therapy
Light & Electrotherapy
Soft Tissue Manipulation
Supervised clinical training

2.4 Type II programme
The Type I programme can be adapted to a Type II programme which is
designed to enable other health-care professionals to obtain additional
qualification as a naturopathic practitioner. Accordingly, the duration and
syllabus of the Type II programme will depend on prior education and
experience, and will vary from student to student. However, the duration should
be no fewer than 1000 hours, including no fewer than 400 hours of supervised
clinical training and the syllabus will be tailored to include any course content
from the Type I programme that had not previously been studied by the student.

3. Safety issues
The community of naturopathy practitioners recognizes a number of
contraindications associated with naturopathic modalities. These
contraindications may be associated with the modalities themselves rather than
the specifically naturopathic use of these treatments. As naturopathy includes
interventions from acupuncture, nutrition, physical therapies, counselling, and
other practices, it is not practical to provide a comprehensive list of
contraindications in this document. Instead, it is recommended that reference be
made to the guidelines of the relevant health-care practices regarding
contraindications to interventions also included in naturopathy. These may
include WHO and WHO Regional Office publications, such as the WHO
Guidelines on basic training and safety in acupuncture (17,18,19).
The foremost principle of naturopathy – primum non nocere – or “first do no
harm”, demands that naturopathic practitioners place patient safety first.
Properly trained naturopathic practitioners know the limitations of, and the
contraindications to, the products and modalities they use. For example, a
properly trained naturopathic practitioner will immediately refer a patient when
circumstances indicate that a patient’s safety and well-being will be put at risk if
that patient is not treated by a different health-care practitioner. Referral is also
indicated when naturopathic treatment is not likely to assist the patient or is not
producing the anticipated positive result.
Referral to other health professionals is specifically indicated when:
• a life-threatening situation occurs or is suspected;
• the diagnosis, assessment or treatment of a specific condition is not within
the scope of naturopathy;
• the diagnosis, assessment or treatment of a specific condition requires
expertise or technology that is not readily available to the naturopathic
• a diagnosis cannot be confirmed with the training and technology that is
available to the naturopathic practitioner;
• the response to treatment is not adequate, or inexplicably unsatisfactory,
or the patient’s condition deteriorates;
• a second opinion is desired.
Such referrals may reduce the risk of indirect adverse effects, which can occur
when an inappropriate treatment is administered; when proper treatment is
delayed or interrupted; when a misdiagnosis is made; or when naturopathic
therapies are used when not indicated.

sabato 13 novembre 2010

Reflusso Gastroesofageo e stile di vita

La malattia da reflusso gastroesofageo (MRGE) è una condizione clinica caratterizzata da reflusso di contenuto gastroduodenale nell’esofago con comparsa di sintomi in grado di interferire con la qualità della vita. I meccanismi fisiopatologici alla base alla base della MRGE sono molteplici ed
includono riduzione del tono dello sfintere esofageo inferiore (LES), transitori rilassamenti del LES, , alterato svuotamento gastrico e ridotta salivazione. I sintomi considerati tipici sono rappresentati dalla pirosi retrosternale (definita dal paziente come sensazione di bruciore che esordisce in corrispondenza dello stomaco o dalla porzione inferiore del torace e che risale verso il collo) e dal rigurgito (percezione di liquido con sapore amaro e acido all’interno della cavità orale),
sintomi la cui specificità per MRGE è pari all’89 e 95%, rispettivamente. Sintomi frequenti ma meno specifici sono l’odinofagia, la disfagia, le eruttazioni, l’ipersalivazione, il dolore epigastrico, il gonfiore, la difficoltà digestiva. Alcuni di questi sintomi caratterizzano la diagnosi di dispepsia funzionale. Fumo, abitudini dietetico-comportamentali (pasti abbondanti, cibi ricchi di grassi,
caffeina), farmaci, gravidanza e obesità possono esacerbare la MRGE. L’ernia iatale si accompagna frequentemente a MRGE e può contribuire alla prolungata esposizione al contenuto gastroduodenale, anche se circa la metà dei pazienti con MRGE non presenta ernia iatale. L’esposizione esofagea al contenuto gastroduodenale può causare danno della mucosa (esofagite) e talora complicanze quali ulcere (circa 5%), sanguinamento (2%) e stenosi (1.2-20%). L’esofago di Barrett (sostituzione del normale epitelio con cellule colonnari metaplastiche) è descritto nel 10% dei pazienti con prolungata esposizione al contenuto gastroduodenale, e può predisporre all’adenocarcinoma. Pazienti con reflusso gastroesofageo possono presentare manifestazioni definite “atipiche” o “extraesofagee” quali dolore toracico non cardiaco, asma bronchiale, tosse cronica, raucedine, globo faringeo, faringodinia, faringite, laringite, perdita di smalto dentario. La terapia, utilizzata in medicina tradizionale, fa abbondante utilizzo di farmaci anti H2 (ranitidina e derivati) o farmaci che bloccano la pompa protonica responsabile della produzione di acido cloridrico nel lume gastrico (omeprazolo e derivati). Questi farmaci, se da un lato contribuiscono alla riduzione dell'acidità gastrica e quindi al contenimento dei sintomi a carico della mucosa gastroesofagea, dall'altro possono provocare acidosi tessutale per la mancata produzione di bicarbonati e alterazioni importanti della fase digestiva con un peggioramento graduale della condizione clinica e la necessità al ricorso di dosi più elevate di farmaci. La naturopatia non cura la MRGE ma, piuttosto, si prende cura della persona affetta da MRGE ponendo l'accento sulle cause ultime del malessere e intervenendo su queste, indagando approfonditamente lo stile di vita e il terreno della persona e individualizzando il trattamento, che si baserà sull'utilizzo di rimedi capaci di agire sugli aspetti fisici, psichici ed emotivi che caratterizzano la MRGE di quella particolare persona. In tal senso è importante valutare se la MRGE debba essere interpretata come un segno di evoluzione diatesico-costituzionale oppure no e quindi attuare il conseguente specifico trattamento naturopatico di fondo. In linea generale, la naturopatia, in circostanze come queste, valuta innanzitutto la risposta infiammatoria del soggetto, l'eventuale distonia del sistema neurovegetativo e lo stile di vita della persona. In questo articolo ci soffermeremo in particolare sull'igiene alimentare e sullo stile di vita da consigliare alle persone affette da MRGE. E' infatti fondamentale un radicale mutamento dello stile di vita per poter ottenere risultati duraturi nel tempo, soprattutto se la MRGE si accompagna ad una ernia iatale. Per quanto riguarda l'alimentazione vi sono alcuni alimenti che, per la loro composizione, sono in grado di esacerbare i sintomi della MRGE. Tra questi ricordiamo :

Carne e pesce ad alto contenuto di grasso - in particolare gli insaccati e affumicati – formaggi, in particolare quelli fermentati , che, per il loro alto contenuto di grassi rallentano la fase digestiva e quindi favoriscono il reflusso gastroesofageo
Bevande alcoliche (soprattutto i superalcolici) Tè, caffè e bibite gassate che possono essere direttamente lesive della mucosa gastrica e , nel contempo, favoriscono la produzione di acido cloridrico.
Alimenti freddi in particolare se a stomaco vuoto come bevande ghiacciate, granite e gelati che possono provocare una reattività eccessiva della mucosa infiammata che si traduce in senso di nausea e vomito
Alimenti poco cotti
Frutta acidula come agrumi - limoni, mandarini, arance, cedro - melograno, ribes e ananas.
Vino bianco e aceto
Verdura come pomodori e succo di pomodoro, peperoni
Fritti e soffritti dovrebbero essere evitati
Dolci industriali in generale e a base di creme in particolare

La dieta più corretta potrebbe essere una dieta prevalentemente vegetariana e, quindi, alcalinizzante che contenga per il 75 % della sua composizione frutta e verdura sia cotta che cruda e per il 25% alimenti proteici selezionati per essere il meno acidificanti possibile. Alcuni suggerimenti possono essere i seguenti:
Succhi di frutta freschi e senza aggiunta di zuccheri, fatta ovviamente eccezione di quelli che contengono ingredienti acidi come gli agrumi
Verdure cotte quali carciofi, cavolo, patate, passati di verdura e minestre a base di verdura
Frutta di stagione cruda, meglio senza buccia, e cotta. Prediligere le banane
Consumare se pur in maniera moderata il latte preferendo però quello parzialmente scremato che grazie al suo contenuto alcalino ha come effetto positivo quello di contrastare e tamponare l'acidità tipica del reflusso.
Yogurt, anche per questo alimento ricordarsi di preferire sempre quelli a basso contenuto di grassi
Alimenti proteici a basso contenuto di lipidi come carni bianche, pesce magro, formaggi magri e non fermentati
Importante poi porre attenzione agli abbinamenti dei cibi in particolare evitare prodotti che contengono proteine con diversa provenienza come nel caso di uova e legumi oppure di carne e formaggi
Preferire sempre cotture leggere, scegliere quindi una cottura alla griglia purchè si presti molta attenzione a non bruciare parti dell'alimento, ottima la bollitura e le cotture saltate purché effettuate con poco olio e di qualità extravergine di oliva
Per la prima colazione vanno bene pane integrale fatto preferibilmente in casa, biscotti secchi (Enerzona) , marmellate senza aggiunta di zucchero (ditta Rigoni di Asiago) e miele.
Si possono inoltre fare alcune considerazioni finali di carattere generale
Quando si escludono abbinamenti come carne e formaggio ovviamente non ci si sta riferendo ad una spolverata di parmigiano od altra tipologia di formaggio.
E' importante effettuare molti piccoli pasti nell'arco della giornata evitando di abbuffarsi in quelli che da molti sono considerati i due pasti principali: il pranzo e la cena.
Altro consiglio molto importante è quello di consumare i propri pasti lentamente così da aiutare l'attività gastrica.
Attenzione alla forma fisica: il sovrappeso non aiuta anzi può peggiorare i sintomi.
Dopo un pranzo abbondante può essere buona abitudine quello di concedersi una breve passeggiata.
Per quel che riguarda invece la componente neurovegetativa, va detto che il reflusso si rinviene spesso in persone ansiose o comunque emotive. La secrezione acida nello stomaco dipende infatti dall’ipotalamo, molto sensibile agli effetti dello stress: nei soggetti stressati si è visto che lo stomaco, invece che i fisiologici 1-2 ml di acido cloridrico, ne produce fino a 50. Diventa essenziale quindi provvedere anche al riequilibrio della sfera psicoemotiva attraverso l'utilizzo di opportuni integratori, da valutare caso per caso, in grado di agire sui sintomi neurovegetativi evidenziati dall'anamnesi naturopatica e da una eventuale indagine iridologica. Tuttavia, anche i rimedi naturali adottati possono sì rappresentare un importante supporto, ma, come i farmaci, non devono diventare una facile soluzione che ci fa dimenticare di intervenire sulle cause. Durante la fase di assestamento dell'alimentazione devono essere considerati un supporto transitorio mentre è assolutamente indispensabile incominciare a cambiare stile di vita, imparando a mantenere quanto più possibile sotto controllo i propri livelli di stress e acquisendo buone abitudini, quali la pratica consuetudinaria di un'attività fisica e di tecniche in grado di riequilibrare la globalità del sistema corpo mente spirito, come esercizi di rilassamento, la meditazione, il tai qi chuan, il qi gong o lo yoga.