Tai Chi for Chronic Fatigue Syndrome


By: Dr Paul Lam
Copyright Dr Paul Lam 2005. Copying for non profit educational purpose is permitted. For Example; you can give your fee paying students this article but not sell to them.

Disclaimer: All persons involved in the writing of this article will not be held responsible in any way whatsoever for any injury or consequence that may arise as a result of following the instructions given in this article. Readers are advised to work with their health professionals before commencing these activities. Readers engaged in activities described in this article do so at their own risk.

Note: This guide is complementary to the program Tai Chi for Back Pain, Wheelchair Bound and Other Chronic Conditions. It is intended to help you to use the program effectively and safely. Dr Paul Lam is the producer of the commercially available instructional DVD of the program.

This article contains a step-by-step guide on how to best use the program for people with chronic fatigue syndrome.

From Clinical Practice Guidelines – 2002 for people with Chronic Fatigue Syndrome (CFS): Produced by a Working Group convened under the auspices of the Royal Australian College of Physicians published by Medical Journal of Australia

“On Physical activity
In general, people with CFS should be encouraged to undertake physical and intellectual tasks, starting at a level that is tolerated without significant exacerbation of symptoms. This should initially be in divided sessions of a relatively short duration. As exercise tolerance improves, duration and intensity of activity can be gradually increased. Graded exercise programs have been shown to be beneficial for some people with CFS, and can improve functional status.
It is important to discuss with the patient the vicious circle whereby initial avoidance of physical activity may lead to longer-term avoidance of all activity. In the early stages of the illness, many people with CFS put off chores or social engagements until they feel better, then push themselves excessively on “good days” to make up for lost time. The subsequent worsening of symptoms and delayed recovery can establish a cyclic pattern of illness and disability.
An individualized management program should be carefully negotiated between the patient and doctor, with particular attention to:
” starting at a level of activity that can be achieved without exacerbation of symptoms – abrupt resumption of strenuous activity after prolonged periods of inactivity should be discouraged;
” undertaking activity on a regular basis, with sessions of limited duration; and
” planning for regular reviews to achieve feasible increases in activity over a realistic time-frame (e.g. several months).
In formulating a management plan, it is important to be aware that in many people with CFS the degree of fatigue can fluctuate unpredictably from day to day and week to week. Flexibility in the level of physical and mental activity undertaken to allow for such fluctuations (“pacing”) should be explicitly discussed.”

There are different levels of severity with CFS, please adjust your level accordingly; if in doubt, discuss with your health professionals.

The advantage of tai chi is that you can use visualization to practice so that in a bad period of your condition you can keep up with your progression without aggravating it.

You can also adjust your level of exertion with regard to how deep is your knees are bent, and how much internal force you are using, as well as the length of time for practice.

Using both the Tai Chi for Back Pain DVD and the Tai Chi for Arthritis handbook (as the Tai Chi for Back Pain is based on the same set of tai chi forms as Tai Chi for Arthritis) can help you learn the program easier, although if possible an instructor who is familiar with your condition is the ideal way to learn.

Work out what is a realistic time to practice daily with your health professional. A rough guide would be how much time you can walk comfortably. If you are a person who is severely affected, you should do minimum physical work possible for you but still do at least 5-10 minutes practice daily using the visualization method.

Adhere to a routine unless there is a medical reason not to. Whenever you feel you could be over-exerting yourself, use visualization to replace physical practice and check with your health professional at any time. Follow the instructions on the DVD, only do what you can within your comfort zone and visualize anything you cannot do.

Let us start:tai chi for back pain workshop in Florida USA 2004

Let us start. Please note: I am using the timing system with the DVD in a (…minutes) to help you locate the specific segment.

1. Starting with the introduction (0 – 11minutes), it contains information of what is back pain, what is tai chi and general precautions for all viewers and specifically for people with back pain. Take care to follow the precautions. Ignore the back pain discussion if you don’t have that problem, however most contents regarding back pain are also helpful for health improvement and back pain prevention. The program is effective for general health improvement especially for people with most chronic conditions.

You don’t need to have back pain to do this program. To find out how it works to improve your health, please read “How Tai Chi Helps Arthritis” in the handbook (p 9), as well as the article “What Can Tai Chi Do for You“.

Also read “Tai Chi Practice” on page 11 of the handbook.

2. Now that you are prepared and understand how to take care of easing into the exercise, let us go to lesson one. Learn the Deep Stabilisers muscle exercises. Be aware that you can do it sitting, lying or standing and with visualization. Try to think about it, contracting the pelvic muscles gently any time during your daily activities. If you don’t have the strength to sit or stand straight, do what is comfortable and visualize sitting straight.

Depending on the level of your condition, spend 1 to 10 days on this before moving on.

More written instructions for the exercises are included at the end of the article. These exercises will enhance your life energy (Qi – see page 47 handbook) therefore enhancing health in general, and improving your level of tai chi. Try to incorporate them slowly into all your tai chi movements.

3. Contents of lesson one (11-40 minutes):

  • Warm up, stretching and cooling down exercises
  • Qigong exercises: 1. The Posture of Infinity 2. The Posture of Tai Chi 3. The Posture of Opening and Closing
  • Movement 1. Commencement

A session of half an hour will be used from now on. The number of session (s) recommended is a guide only, use more session if required. Avoid going faster than recommended unless you and your health professional are sure that you can do it. Patience is part of tai chi philosophy.

If you feel that is too long and ten minutes is the best for you, simply divide it into three sessions to cover the same content. Tai chi is not about how many forms you can learn, and how fast you are learning. Rather it is more about how well you understand the principles and integrates them into your practice. Practicing with visualization can be just as effective.

Use one to three sessions to learn the warm up and cooling down exercises. Practice another one to three sessions until you are comfortable at doing them before moving on.

4. Use one to three sessions to learn the three Qigong exercises. Practice several sessions until you are ready before moving on. Always do warm up before starting and cool down when finishing for your future tai chi exercises. The Qigong exercises can be brought up anytime, for example when you are sitting down waiting for your doctor, you can physically or mentally adjust your posture, be aware of the dan tian and breathe gently using abdominal muscles.

5. Having done your warm up exercises, revise the previous contents before starting the new movements. There is no hurry, pacing yourself is part of tai chi philosophy; tai chi is a way of life to many of us – the way of life is nature. Nature moves when it is ready, no one needs to hurry nature and it would not work if you tried.

Movement 1 can be learned any time you are ready using one to three sessions. Practice a similar number of sessions for each new exercise you learn; only move on when it feels comfortable to do so.

6. Contents of lesson two (40- 47 minutes).

  • Qigong exercises:

    4. The Posture of Yin Yang Harmony

  • Movement 2 – Opening and Closing Hands
  • Movement 3 – Single Whip


Remember in tai chi, it is important to control your movements so that they are slow, even and continuous rather than moving fast and getting over as many movements as possible. Tai chi is different from the fast paced world we are now a part of. Tai chi philosophy is that moving slower may get you closer to nature and health faster, and moving in curves can be more effective than a straight line.

You can learn the 4th Qigong (pronounce as chee gong) exercise in one or two sessions. Practice all four Qigong exercises together once you remember them.

Movement 2 should take one to two sessions; remember to practice before moving on.

Movement 3 should take one to four sessions, and same sessions for practice.

If you encounter any discomfort or problems, discuss with your health professionals or instructor. It is a good idea to check with your health professional every now and report how you are getting along.

Link everything you have learned and practice in a sequence. For example, once you have learned movement 1 and 2, practice them together, and then when you have learned movement 3, continue to practice 1,2 and 3 together in a sequence.

7. Lesson 3 (47-59 minutes) begins to put everything together; the natural flow of tai chi is beginning to show.

The contents are:

  • Movement 4 – Waving Hands in the Cloud.
  • Movement 5 – Opening and Closing Hands
  • Movement 6 – Closing
  • Both sides of the six movements


As a general rule, I recommend two to four sessions per movement and a similar numbers of sessions for practice. By now you should have a rough idea of what you can do; if you are not sure, go for the conservative approach. Movement 4 is more difficult, you may need more time, whereas movement 5 and 6 are repetitions which do not require much time to pick up.

You may need to give yourself more time to learn and practice the Basic Six set to the other side.

8. Depending on how well you have done the previous lessons, you can adjust your speed accordingly.

Now you should read “Six Tai Chi Principles for Beginners” at page 53 of the handbook, as listed below.


Tai chi contains essential principles, all of which are fundamental and similar in the different styles. When you concentrate on the essential, you speed up your progression, and you improve, no matter what style you do. Don’t worry about the minor details. Focus your practise on these principles.

In my workshops and videos, I mention these essential principles. Here, I’ve converted them into simple, easy to understand terms. They are classified into: Movement; body and internal.

1. Make your movements slow, even and continuous, maintaining the same speed throughout. In other words, control your movements.

2. Move as though there is a gentle resistance. Imagine that the air around you is dense and you have to move against this dense air. This will help you cultivate your inner force.

3. Be aware of your weight transference. First, centre yourself, then control your balance, keeping your body alignments, and when you move backwards, forwards or sideways, touch down first, then gradually and consciously transfer your weight forward or backward.

4. Body Alignments. Be sure you keep your body in an upright position.

5. Loosening the joints. It is important to do the Tai Chi movements in a relaxed manner but relaxation here does not mean that all your muscles go floppy. You should be stretching, loosening. Try consciously and gently stretch every joint from within, almost like an internal expansion of the joints.

6. Mental Focus. Be sure not to let your mind distract what you are doing and focus on your movement so that your internal and external are well integrated.

Try to work on one principle at a time, for several sessions, until you feel proficient with it, then pick up another principle to practice with the Basic set you have done so far. Keep practicing with all principles before moving on to the next lesson.

These are the contents of the remainder of the lessons:

Lesson 4 – moving (59 minutes -1 hour 30 minutes)

  • Warm up, stretching and cooling exercises
  • Qigong exercises
  • Both sides of the six movements


Lesson 5 – moving (- 1 hour 38 minutes)

  • Advanced movement 1 – Brush Knee
  • Advanced movement 2 – Playing the Lute


Lesson 6 – moving (- 1 HOUR 44 minutes)

  • Advanced movement 3 – Parry and Punch


Lesson 7 – moving (- 1 hour 47 minutes)

  • Advanced movement 4 – Apparent close up
  • Advanced movement 5 – Pushing the Mountain
  • Advanced movement 6 – Opening and Closing


Lesson 8 – moving ( – 1 hour 50 minutes)

  • Both sides of the advanced 6 movements


A Few points to consider:

Use the recommended general rule of learning a movement in two to five sessions. If standing and moving around takes too much energy, you should sit down most of the time and slowly add a small portion of moving practice. Progressively increase your exertion level according to your condition, be conservative but consistent.

After lesson 4 you should practice for a period of one to four months before moving on. Many people gain significant benefits from practicing these initial movements. You should continue to practice these until you notice your fitness and health has improved, and you are confident with your forms before moving on.

Go back to the tai chi principles regularly, as you progress further in tai chi, they will take a some what different meaning to you. Tai chi’s immense depth comes from its essential principles.

After lesson 8 and practice for a suitable period of time, and having done the six principles several times, you can move on the Ten Essential Principles on page 54 of the handbook. You will find the fundamental principles in tai chi are similar and can appear simple, to appreciate their depth you need to practice. Through practice you can learn and enjoy the different layers of tai chi inner meanings. By now you might need a suitable instructor to progress further and to help interpret these principles. Read my book “Overcoming Arthritis” published by DK on how to find a good tai chi teacher, or the article of this topic on my website in the article section.

If you are unable to find a suitable instructor and if your progression is going to be very different from the other people, consider having private lessons. You are welcome to write to me for any advice or information. The best way to contact me is online via email to [email protected] . Or write to: C/O Dr Paul Lam, Tai Chi Productions, 6 Fisher Place, Narwee, NSW 2209, Australia.

Best wishes for a healthier and better quality of life, and enjoy the journey.



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